Background/Purpose

The 2013 update of the EULAR recommendations for the management of RA with synthetic and biological DMARDs set non-anti-TNF- α as first-line biological treatments.  Yet, available data regarding treatment after rituximab, abatacept and tocilizumab failure is weak. The objective of this study was to compare continuation rates of second line non-anti-TNF- α treatments after a first non-anti-TNF- α failure.

Methods

This retrospective multicentre study included patients treated for RA with rituximab, abatacept or tocilizumab after having received in a previous line abatacept, tocilizumab or rituximab from 2002 to 2013. Data were collected from patients’ file including baseline and final DAS28-ESR and DAS28-CRP for both lines of treatment, motives for treatment introduction and discontinuation. Follow-up of the second line of treatment was one year. The primary endpoint was the continuation rate at the end of the first year of treatment.

Results

A total of 100 patients were included.  Patients had previously received an average of 2.6 (+/- 0.9) biological DMARDs. Patients were aged 55.4 (+/- 11.5) years and disease duration was 14.3 (+/- 9.4) years. In first line, 29 patients were treated with tocilizumab, 26 with abatacept and 45 received rituximab. In second line of treatment, 49 patients were treated with abatacept, 36 received tocilizumab and 15 rituximab.  Methotrexate was associated in 36% of cases.  The first line of treatment was continued for 15.6  (+/- 14.4) months. At baseline, DAS28-ESR was 5.57 (+/- 1.19) and DAS28-CRP was 5.25 (+/- 1.15) for the first line and DAS28-ESR was 5.00 (+/- 1.41) and DAS28-CRP was 4.84 (+/- 1.22) for the second line of treatment. Treatment continuation rates at the end of the first year was 45.9% in first line and 58.6% in second line of treatment (p=0.10). In patients without Methotrexate, continuation rates at the end of the first year was 37.5% for the first line of treatment and 64.3% in the second line (p=0.009). In the first line of treatment, 66.6% of patients that interrupted their treatment for a reason of intolerance in the first year of treatment  versus 15.5% in the second line of treatment.

Conclusion

After a first non-anti-TNF- α biological DMARD failure, continuation rates at one year are similar in the second line of non-anti-TNF- α treatment. Association to Methotrexate does not seem to bring any benefits in the second line of treatment.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/first-and-second-line-continuation-rates-of-non-anti-tnf-%ce%b1-biological-dmard-for-the-treatment-of-rheumatoid-arthritis/