Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Biologic therapy targeting TNF have consistently demonstrated better efficacy and effectiveness when combined with a conventional synthetic DMARD (csDMARD), most frequently methotrexate. Although pre-clinical protocols have shown the short-term efficacy of tocilizumab (TOCI) in monotherapy in very selected patients suffering from rheumatoid arthritis (RA), little is known on the long-term comparative sustainability of monotherapy (Mono) versus combo therapy (Combo). We evaluate here the comparative sustainability of tocilizumab in patients with rheumatoid arthritis initially treated with or without MTX.
Methods: Data from RHUMADATA® patients with RA prescribed TOCI either as an initial or second biologic was analyzed. Patients were followed until treatment discontinuation, loss to follow-up or April 22nd, 2018. The characteristics of selected patients were tabulated and the TOCI discontinuation rates of patients undergoing initial mono and combo therapy compared using Kaplan-Meier methods and Cox regression models adjusting for potential confounders.
Results: A total of 122 patients with RA received TOCI in first or second intention. Of those, 44(36.1%) and 78(63.9%) initially received mono and combo therapy respectively. Most patients were women (77%), mean age at diagnosis was 45.0 (SD=12.8) years, and the average age at treatment initiation was 54.5 (SD=11.8) years. HAQ and DAS28(4)-CRP at treatment initiation were respectively 1.21 (SD=0.57) and 4.64 (SD=1.01). Forty-nine and 11 percent of patients concomitantly received hydroxychloroquine (HCQ) and sulfasalazine (SSZ) respectively. Age-adjusted Carlson’s comorbidity index (ACCI) at baseline was 2.5 (SD=1.1), and 79% were RF-positive and 75% ACPA positive. Significant differences in retention rates between mono and combo TOCI therapy were observed (log-rank p-value =0.0002). Mean retention time for mono and combo-therapy were respectively 2.77(SE=0.41) and 5.13(SE=0.43) years. Use of MTX remains significant (p-value<.0001) after adjusting for gender, age and disease duration at treatment initiation, HAQ, DAS28(4)-CRP, RF and ACPA, ACCI, and concomitant use of HCQ and SSZ.
Conclusion: Combining tocilizumab with MTX significantly improves its sustainability.
To cite this abstract in AMA style:Choquette D, Bessette L, Brown J, Haraoui B, Massicotte F, Pelletier JP, Raynauld JP, Rémillard MA, Sauvageau D, Turcotte A, Villeneuve É, Coupal L. Combining Tocilizumab with Methotrexate Improves Sustainability. Real World Evidence Report from Quebec Database Rhumadata® [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/combining-tocilizumab-with-methotrexate-improves-sustainability-real-world-evidence-report-from-quebec-database-rhumadata/. Accessed January 18, 2020.
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