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Abstract Number: 495

Comparison of Discontinuation Rates by Biologic Since 1998 in US Patients with Rheumatoid Arthritis

Sofia Ramiro1, Frederick Wolfe2, David J. Harrison3, George Joseph3, David H. Collier3, Désirée van der Heijde4, Robert Landewé5 and Kaleb Michaud6, 1Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, The Netherlands and Hospital Garcia de Orta, Almada, Portugal, 2National Data Bank for Rheumatic Diseases, Wichita, KS, 3Amgen Inc., Thousand Oaks, CA, 4Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 5Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam and Atrium Medical Center, Heerlen, Netherlands, 6Rheumatology, National Data Bank for Rheumatic Diseases & University of Nebraska Medical Center, Omaha, NE

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: biologic response modifiers, outcome measures and rheumatoid arthritis (RA)

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Session Information

Session Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy

Session Type: Abstract Submissions (ACR)

Background/Purpose: Since discontinuation may be a surrogate for ineffectiveness, we measured rates and reasons for biologic discontinuation in a real-world setting.

Methods: From 1998 to 2011, all medication use was measured every 6 months via questionnaire in a US-wide longitudinal study of RA patients. We limited our analysis to patients with a baseline observation immediately before initiating their first (1st) or second different (2nd) biologic and at least one observation after initiation. Patients reported their primary reason for discontinuation. Time-on-drug survival analyses were conducted for individual biologics and groups and annual rates reported. Survival of anti-TNFs and non-anti-TNFs was compared, in crude and adjusted in propensity score analyses.

Results: A total of 2,340 RA patients initiated their 1st biologic; 1,148 (49%) discontinued and 1,128 initiated their 2nd; 567 (50%) discontinued. The vast majority initiated one of the following: etanercept (1st 44%, 28% 2nd), infliximab (1st 37%, 38% 2nd), and adalimumab (1st 13%, 19% 2nd). The annual discontinuation rate of all 1st biologics was 18% (95% CI 17-19%) and 2nd was 21% (19-23%). Annual discontinuation rates for 1st and 2nd by drug was 15% (14-16%) and 16% (14-19%) for etanercept; 19% (17-21%) and 18% (16-20%) for infliximab; and 20% (17-23%) and 26% (22-32%) for adalimumab. Anakinra had the highest annual rates, 1st 59% (44-78%) and 2nd 106% (74-151%). Patients who started a biologic after 2005 had higher annual discontinuation rates, 1st 25% (22-29%) and 2nd 31% (27-35%). Anti-TNF had lower annual discontinuation rates vs non-anti-TNF (1st); crude HR 0.48 (0.34-0.69) and after propensity score adjustment, HR of 0.60 (0.40-0.90). For 2nd line, a crude HR of 0.64 (0.48-0.84) and adjusted HR of 0.81 (0.59-1.11) (see Figures). Reporting a side effect had the highest discontinuation rate, 1st 63% and 2nd =81%, followed by reporting the drug was “not working”, 1st 49% and 2nd 60%.

Conclusion: In this large cohort, RA patients tend to remain on their initial and second biologic for relatively long periods suggesting the drugs’ effectiveness. Discontinuation rates were higher for non-anti-TNFs and in patients who initiated a biologic more recently when more treatment options were available. Contrary to recent findings, there was no statistically significant difference in discontinuation rates of anti-TNFs and non-anti TNFs as second biologic treatment.  

 


Disclosure:

S. Ramiro,
None;

F. Wolfe,
None;

D. J. Harrison,

Amgen,

1,

Amgen,

3;

G. Joseph,

Amgen Inc.,

1,

Amgen Inc.,

3;

D. H. Collier,

Amgen Inc.,

1,

Amgen Inc.,

3;

D. van der Heijde,

Abbott, Amgen, AstraZeneca, BMS, Centocor, Chugai, Eli-Lilly, GSK, Merck, Novartis, Otsuka, Pfizer Inc., Roche, Sanofi-Aventis, Schering-Plough, UCB, Wyeth,

5,

Imaging Rheumatology,

4;

R. Landewé,

Rheumatology Consultancy BV ,

4,

Abbott, Amgen, AstraZeneca, BMS, Centocor, GSK, Merck, Novartis, Pfizer, Roche, Schering-Plough, UCB, Wyeth,

5;

K. Michaud,
None.

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