Drug Retention and Discontinuation Reasons Between Seven Biologics in Patients with Takayasu Arteritis

Corrado Campochiaro¹, Alessandro Tomelleri ², Silvia Sartorelli ³, Giulio Cavalli ², De Luca Giacomo ⁴, Elena Baldissera ² and Lorenzo Dagna ², ¹Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy, ²Unit of Immunology, Rheumatology, Allergy and Rare Diseases. IRCCS San Raffaele Hospital. Vita-Salute San Raffaele University., Milan, Italy, ³Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy, ⁴Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy., Milan, Italy

Meeting: ACR/ARP Annual Meeting 2019

Keywords: Biologic agents, Takayasu arteritis, tocilizumab and large vessel vasculitis, Tumor necrosis factor (TNF)

Session Information

Date: Sunday, November 10, 2019

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster I: Takayasu's Arteritis & Polymyalgia Rheumatica

Session Type: Poster Session (Sunday)

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

Background/Purpose: Takayasu’s arteritis (TA) is a large vessel vasculitis affecting mainly young women. Biologic agents are currently use to treat refractory TA patients but no data are available on drug retention rate (DRR) of biologic disease-modifying anti-rheumatic drugs (bDMARDs) TA patients. We retrospectively investigated DRR and reasons for discontinuation of seven bDMARDs in TA patients in a real-world setting.

Methods: TA patients followed-up in our Centre fulfilling the 1990 ACR criteria and treated with ≥1 bDMARD were selected. Data about disease duration, number of bDMARDs, reasons for bDMARDs discontinuation, concomitant conventional synthetic (cs)DMARDs were collected. Survival curves were examined by the Kaplan-Meier method and compared using a stratified log-rank test. 24-month DRR was calculated. Hazard ratio (HR) for concomitant csDMARDs and for previous bDMARDs was evaluated. A comparative sub-analysis between anti-TNFα drugs and tocilizumab was performed.

Results: We identified 50 patients and 86 bDMARD-courses. Patients characteristics are summerized in Table 1.No significant differences were observed in age and disease duration between the seven groups (data not shown). Infliximab was the most frequent first-line bDMARD (78.6%). At bDMARDs initiation, all patients were on prednisone (mean dose, 13.5±10.3 mg/day) and 85.2% on concomitant csDMARD therapy. 43% of treatment courses were stopped by 24 months. Golimumab had the highest DRR (71.4%), followed by infliximab (69%), adalimumab (56.3%), abatacept (50%), tocilizumab (41.1%), anakinra (0%) and rituximab (0%), p=0.016. Concomitant csDMARDs therapy showed positive effects on DRR (HR=2.87, 95% CI=1.19-6.92, p=0.019). Anti-TNFα drugs had significantly higher DRR compared to tocilizumab (67.2% vs 41.1%, p=0.028), see Figure 1. Even in these subgroups, csDMARDs showed positive effects on DRR (HR=3.79, 95% CI=1.49-9.6, p=0.005).

Conclusion: Anti-TNFα agents had the highest DRR overall and a higher DRR in a head-to-head comparison with tocilizumab. Concomitant csDMARDs had a significant positive effect on bDMARDs DRR.

Table 1 Taka

Figure 1 Taka

Disclosure: C. Campochiaro, GSK, 8, GSK, SOBI, Pfizer, 5, 8, Pfizer, 8, SOBI, 5; A. Tomelleri, None; S. Sartorelli, None; G. Cavalli, SOBI, Novartis, Pfizer, 5, 8; D. Giacomo, GSK, 8, Pfitzer, 8, SOBI, 5, SOBI, Novartis, SOBI, Pfizer, 5, 8; E. Baldissera, Sobi, 8, Sanofi, 5, Roche, 8, Pfizer, 8, Novartis, 8, Abbvie, 8, Alfa-sigma, 8; L. Dagna, Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Sanofi-Genzyme, and SOBI., 5, 8.

To cite this abstract in AMA style:

Campochiaro C, Tomelleri A, Sartorelli S, Cavalli G, Giacomo D, Baldissera E, Dagna L. Drug Retention and Discontinuation Reasons Between Seven Biologics in Patients with Takayasu Arteritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/drug-retention-and-discontinuation-reasons-between-seven-biologics-in-patients-with-takayasu-arteritis/. Accessed .

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