Do Canadian Rheumatologists Actually Treat to Target Once a Biologic Has Been Initiated? an Analysis from a Prospective, Observational Registry

Philip Baer¹, Andrew Chow², Michael Starr³, Boulos Haraoui⁴, Regan Arendse⁵, Michelle Teo⁶, Emmanouil Rampakakis⁷, Eliofotisti Psaradellis⁸, Allen J Lehman⁹, Francois Nantel¹⁰, Brendan Osborne¹¹, Cathy Tkaczyk¹¹ and Karina Maslova⁹, ¹Independent Rheumatology Practice, Scarborough, ON, Canada, ²Credit Valley Rheumatology, Mississauga, ON, Canada, ³Rheumatology, Mcgill University, Pointe-Claire,, QC, Canada, ⁴University of Montreal, Montreal, QC, Canada, ⁵University of Saskatchewan, Saskatoon, SK, Canada, ⁶Balfour Medical Clinic, Penticton, BC, Canada, ⁷JSS Medical Research, St-Laurent, QC, Canada, ⁸JSS Medical Research, Montreal, QC, Canada, ⁹Janssen Inc., Toronto, ON, Canada, ¹⁰19 Green belt Dr, Janssen Inc., Toronto, ON, Canada, ¹¹Medical Affairs, Janssen Inc., Toronto, ON, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: anti-TNF therapy

Session Information

Date: Sunday, November 13, 2016

Session Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy - Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The objective of this analysis was to assess the frequency of treatment optimization in cases where treatment target was not achieved, and to describe the type of changes made in RA patients initiating treatment with infliximab or golimumab in Canadian routine clinical care.

Methods: BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis, or psoriatic arthritis with infliximab, golimumab or ustekinumab. RA patients enrolled during 2002-2014 and with available CDAI information at both months 6 and 12 were included. DA was defined according to the CDAI criteria (remission: ≤2.8; low: >2.8 to ≤10; moderate: >10 to ≤22; high: >22). The association between treatment changes and target achievement was assessed with the Chi-square test.

Results: A total of 498 patients were included, with a mean (SD) age and disease duration of 56.4 (13.2) and 8.6 (8.6) years, respectively. The majority of patients were female (74.1%) and treated with infliximab (74.5%). After 6 months of treatment, 46% of patients had achieved treatment target of remission or low DA, and 54% were still at moderate/high DA. Among the latter, treatment was adjusted in 36.4% (34.7% when looking only at patients enrolled since 2011) and was significantly associated with target achievement at month 12 (46.9% vs. 31%; P=0.009). The frequency of treatment changes by type were: DMARD switch/add-on (11.9% of patients), biologic up-titration (10%), DMARD up-titration (8.2%), steroid initiation (7.8%), NSAID initiation (5.6%), and DMARD initiation (3%). Among patients at moderate/high DA at both visits for whom no treatment adjustment was made, mean (SD) disease parameters at 6 months were: SJC28 = 5.7 (5.0); TJC28 = 8.6 (6.5); MDGA = 3.8 (2.0); PtGA = 4.5 (2.4). In comparison, among patients with treatment adjustment, disease parameters were: SJC28 = 5.8 (4.2); TJC28 = 9.4 (7.0); MDGA = 4.7 (2.3); PtGA = 5.8 (2.1). Among patients at moderate/high DA at 6 months who achieved target at month 12 without treatment adjustment, disease parameters at month 6 were: SJC28 = 4.7 (4.5); TJC28 = 5.5 (5.1); MDGA = 3.2 (1.7); PtGA = 4.3 (2.5). Among those with a treatment adjustment, disease parameters at month 6 were: SJC28 = 3.5 (3.0); TJC28 = 5.1 (3.3); MDGA = 4.2 (2.2); PtGA = 4.7 (2.8).

Conclusion: These results suggest that a considerable portion of patients on biologics are not treated to a CRA recommended target in Canada. Treatment adjustment was found to be mainly associated with the physician’s global assessment of disease activity and resulted in better outcomes. PtGA and TJC28 were also significantly higher in those receiving treatment adjustments, while SJC did not correlate with treatment adjustments. The reasons for lack of treatment adjustment in patients not at DA target levels should be further explored.

Disclosure: P. Baer, Janssen Inc., 5; A. Chow, Janssen Inc., 5; M. Starr, Janssen Inc., 5; B. Haraoui, Janssen Inc., 5; R. Arendse, Paid Consultant of Janssen Inc., Canada, 5; M. Teo, Janssen Inc., 5; E. Rampakakis, employee of JSS Medical Research, 3; E. Psaradellis, employee of JSS Medical Research, 3; A. J. Lehman, Employee of Janssen Inc., 3; F. Nantel, Employee of Janssen Inc., 3; B. Osborne, Employee of Janssen Inc., 3; C. Tkaczyk, Employee of Janssen Inc., 3; K. Maslova, Employee of Janssen Inc., 3.

To cite this abstract in AMA style:

Baer P, Chow A, Starr M, Haraoui B, Arendse R, Teo M, Rampakakis E, Psaradellis E, Lehman AJ, Nantel F, Osborne B, Tkaczyk C, Maslova K. Do Canadian Rheumatologists Actually Treat to Target Once a Biologic Has Been Initiated? an Analysis from a Prospective, Observational Registry [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/do-canadian-rheumatologists-actually-treat-to-target-once-a-biologic-has-been-initiated-an-analysis-from-a-prospective-observational-registry/. Accessed January 15, 2021.

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