ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1088

Does Drug Effectiveness of 2nd and 3rd TNF Inhibitors in Patients with Psoriatic Arthritis Depend on the Reason for Withdrawal from the Previous Treatment? – Results from the EuroSpA Research Collaboration

Cecilie Heegaard Brahe1, Lykke Midtbøll Ørnbjerg 1, Lennart Jacobsson 2, Michael J. Nissen 3, Eirik Kristianslund 4, Herman Mann 5, Maria José Santos 6, Manuel Pombo-Suarez 7, Dan Nordström 8, Ziga Rotar 9, Bjorn Gudbjornsson 10, Fatos Onen 11, Catalin Codreanu 12, Anne Gitte Loft 13, Ulf Lindström 14, Burkhard Moeller 15, Joe Sexton 16, Karel Pavelka 5, Anabela Barcelos 17, Carlos Sánchez-Piedra 18, Kari K. Eklund 19, Matija Tomsic 20, Thorvardur J Love 21, Gercek Can 22, Ruxandra IONESCU 23, Marleen van de Sande 24, Irene van der Horst-Bruinsma 25, Gareth Jones 26, Florenzo Iannone 27, Brigitte Michelsen 1, Lise Hyldstrup 28, Niels Steen Krogh 29, Mikkel Østergaard 30 and Merete Lund Hetland 31, 1EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Glostrup, Denmark, 2Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,, Gothenburg, Sweden, 3University Hospital Geneva, Geneva, Switzerland, 4Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway., Oslo, Norway, 5Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Prague, Czech Republic, Prague 2, Czech Republic, 6Rheumatology department, Hospital Garcia de Orta, Almada, Portugal, 7Rheumatology Unit, Clinical University Hospital of Santiago de Compostela,, Santiago, Spain, 8Department of Medicine, ROB-FIN, Helsinki University Hospital and Helsinki University, Helsinki, Finland., Helsinki, Finland, 9UMC LJUBLJANA, DPT. OF RHEUMATOLOGY, LJUBLJANA, Slovenia, 10Centre for Rheumatology Research, Landspitali and Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 11Dokuz Eylul University School of Medicine, Division of Rheumatology, İzmir, Turkey, 12Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania., Bucharest, Romania, 13Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, Århus, Denmark, 14University of Gothenburg, Gothenburg, Sweden, 15University Hospital Bern, Bern, Switzerland, 16Diakonhjemmet Hospital, Dept. of Rheumatology, Oslo, Norway, 17Centro Hospitalar Baixo Vouga | iBemed, University of Aveiro, Aveiro, Portugal, 18Research Unit, Spanish Society of Rheumatology, Madrid, Spain, 19ROB-FIN registry, Department of Medicine, Helsinki University and University Hospital, Helsinki, Finland, 20Department of Rheumatology, University Medical Center Ljubljana, Slovenia, Ljubljana, Slovenia, 21Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 22TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University,, Izmir, Turkey, 23SPITALUL CLINIC SFANTA MARIA, Bucharest, 24Amsterdam UMC, Amsterdam, Netherlands, 25Amsterdam University Medical Center, Amsterdam, Netherlands, 26University of Aberdeen, Aberdeen, United Kingdom, 27Department of Emergency and Transplantation , Rheumatology Unit, University Hospital of Bari, Bari, Italy., Bari, Italy, 28Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark, Copenhagen, Denmark, 29Zitelab / DANBIO, Copenhagen, Denmark, 30Copenhagen Center for Arthritis Research, University of Copenhagen, Copenhagen, Denmark, 31DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ,

Session Information

Date: Monday, November 11, 2019

Title: Epidemiology & Public Health Poster II: Spondyloarthritis & Connective Tissue Disease

Session Type: Poster Session (Monday)

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

Background/Purpose: Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients switch to a different TNFi because of adverse events (AE) or lack of effect (LOE). The EuroSpA Collaboration has previously demonstrated a 1-year retention rate of 77% and 6 months LUNDEX adjusted 28-joint count Disease Activity Score (DAS28) remission rates of 45%1 in patients with PsA initiating the first TNFi treatment. Little is known about the effectiveness of switching to a second and third TNFi in patients with PsA.
We aim to investigate retention and remission rates at 6, 12 and 24 months in patients with PsA initiating the 2nd and 3rd TNFi in clinical practice across Europe. Secondly, to investigate whether the outcomes are associated with the reason for withdrawal (AE or LOE) from the previous TNFi-treatment.

Methods: Prospectively collected data on PsA patients in routine care from 12 European registries were pooled. Kaplan-Meier estimation was used to investigate TNFi retention rates. LUNDEX adjusted2 remission rates were calculated for DAS28< 2.6 and 28 joint Disease Activity index for Psoriatic Arthritis (DAPSA28) ≤4. Group comparisons were performed by Chi-square test.

Results: A total of 4971 patients initiating their 2nd TNFi and 1768 patients initiating their 3rd TNFi were included. Baseline characteristics are shown in the Table.
The overall retention rates for 2nd and 3rd TNFi at 12 months were 69% (67-70%) and 66% (64-68%), (2nd vs 3rd p=0.053), respectively (Figure). Corresponding retention rates for the individual registries ranged from 48-100% and 49-91%, respectively. If patients had stopped the 1st TNFi due to AE or LOE, 12-month retention rates for the 2nd TNFi treatment were 66% and 65%, respectively. In patients who stopped the 2nd TNFi due to AE or LOE, 12-month retention rates for the 3rd TNFi treatment were 65% and 63%, respectively.
For the 2nd and 3rd TNFi, 6 months LUNDEX adjusted DAS28 remission rates were 35% and 27% (p< 0.001), respectively, and for DAPSA28 remission 14% and 10% (p=0.008) (Table).

Conclusion: The EuroSpA Collaboration demonstrated decreasing retention and remission rates with increasing number of previous TNFi, although with only minor difference between 2nd and 3rd.  Patients who had withdrawn from the previous TNFi due to LOE had retention rates and remission rates similar to those who had withdrawn due to AE.

Acknowledgement
Novartis Pharma AG and IQVIA for supporting the EuroSpA collaboration. 

References
1Brahe et al. ACR 2018
2Arthritis Rheum, 2006, 54(2), p:600-6


Table

Disclosure: C. Brahe, Novartis, 2; L. Midtbøll Ørnbjerg, Novartis, 2; L. Jacobsson, None; M. Nissen, Abbvie, Celgene, Lilly, MSD, Novartis, Pfizer, 5, 8; E. Kristianslund, None; H. Mann, None; M. Santos, AbbVie, 8, Biogen, 8, Novartis, 8, Pfizer, 8, Roche, 8; M. Pombo-Suarez, None; D. Nordström, AbbVie, 5, 8, BMS, 5, 8, Celgene, 5, 8, Lilly, 5, 8, MSD, 2, 4, 8, Novartis, 5, 8, Pfizer, 2, 5, 8, Roche, 2, 5, 8, UCB, 5, 8; Z. Rotar, AbbVie, 9, Amgen, 5, 8, Eli-Lilly, 9, MSD, 5, Novartis, 9, Pfizer, 9, Sanofi, 5; B. Gudbjornsson, Actavis, 8, Amgen, 8, Novartis, 8, Pfizer, 8; F. Onen, Tofacitinib (Pfizer), 8; C. Codreanu, AbbVie, 5, 8, Egis, 5, 8, Eli-Lilly, 5, 8, Ewopharma, 5, 8, Mylan, 5, 8, Novartis/Sandoz, 5, 8, Pfizer, 5, 8, Roche, 5, 8, UCB, 5, 8; A. Loft, None; U. Lindström, None; B. Moeller, AbbVie, 2, 8, Eli Lilly, 2, 8, Janssen, 2, 8, Merck, 2, 8, Novartis, 2, 8, Pfizer, 2, 8, UCB, 2, 9; J. Sexton, None; K. Pavelka, AbbVie, 8, Abbvie, 5, 8, Amgen, 5, 8, BMS, 8, Egis, 5, 8, Lilly, 5, 8, MSD, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8, UCB, 8; A. Barcelos, Bene, 8, MSD, 5, 8, Pfizer, 5, 8, Novartis, 5, 8, Eli-Lilly, 5; C. Sánchez-Piedra, None; K. Eklund, None; M. Tomsic, None; T. Love, None; G. Can, None; R. IONESCU, Abbvie, 5, 8, Amgen, 5, 8, Alpha Sigma, 5, 8, BMS, 5, 8, Ewopharma, 5, 8, Lilly, 5, 8, Mylan, 5, 8, Novartis, 5, 8, MSD, 5, 8, Pfizer, 5, 8, UCB, 5, 8, Roche, 5, 8, Sandoz, 5, 8; M. van de Sande, None; I. van der Horst-Bruinsma, AbbVie, 2, 5, 8, Bristol Myers-Squibb, 2, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, UCB Pharma, 2, 5, 8; G. Jones, Celgene, 2; F. Iannone, AbbVie, 5, 8, BMS, 5, 8, Janssen, 5, 8, lilly, 5, 8, Lilly, 5, 8, MSD, 2, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8, Sanofi, 5, 8, UCB, 5, 8; B. Michelsen, Novartis, 2; L. Hyldstrup, Novartis, 2; N. Krogh, None; M. Østergaard, AbbVie, 2, 8, 9, Abbvie, 2, 5, 8, Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB, 5, 8, Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, 5, 8, Abbvie, Celgene, Centocor, Merck, and Novartis, 2, Abbvie, Celgene, Centocor, Merck, Novartis, 2, BMS, 2, 5, 8, 9, Boehringer Ingelheim, 5, 8, Boehringer-Ingelheim, 2, 8, Boehringer-ingelheim, 9, Celgene, 2, 5, 8, Centocor, 2, Eli Lilly, 5, 8, 9, Eli Lilly and Company, 5, 8, Eli-Lilly, 2, 8, Hospira, 2, 5, 8, Janssen, 2, 5, 8, 9, Merck, 2, 5, 8, 9, Novartis, 2, 5, 8, Novo, 2, 5, 8, Novo Nordisk, 5, 8, Orion, 2, 5, 8, Pfizer, 2, 5, 8, 9, Regeneron, 2, 5, 8, Roche, 2, 5, 8, roche, 9, Sandoz, 2, 8, Sanofi, 2, 8, UCB, 2, 5, 8; M. Lund Hetland, Abbvie, 2, AbbVie, 2, Biogen, 2, BMS, 2, CellTrion, 2, 9, MSD, 2, Novartis, 2, Orion, 2, Pfizer, 2, Samsung, 2, UCB, 2.

To cite this abstract in AMA style:

Brahe C, Midtbøll Ørnbjerg L, Jacobsson L, Nissen M, Kristianslund E, Mann H, Santos M, Pombo-Suarez M, Nordström D, Rotar Z, Gudbjornsson B, Onen F, Codreanu C, Loft A, Lindström U, Moeller B, Sexton J, Pavelka K, Barcelos A, Sánchez-Piedra C, Eklund K, Tomsic M, Love T, Can G, IONESCU R, van de Sande M, van der Horst-Bruinsma I, Jones G, Iannone F, Michelsen B, Hyldstrup L, Krogh N, Østergaard M, Lund Hetland M. Does Drug Effectiveness of 2nd and 3rd TNF Inhibitors in Patients with Psoriatic Arthritis Depend on the Reason for Withdrawal from the Previous Treatment? – Results from the EuroSpA Research Collaboration [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/does-drug-effectiveness-of-2nd-and-3rd-tnf-inhibitors-in-patients-with-psoriatic-arthritis-depend-on-the-reason-for-withdrawal-from-the-previous-treatment-results-from-the-eurospa-research/. Accessed .

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