Session Information
Date: Tuesday, November 10, 2015
Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Despite disease modifying anti-rheumatic drugs (bDMARDs), glucocorticoids (GCs) are still widely prescribed in rheumatoid arthritis (RA). GCs are associated with numerous potential side effects, in particular for prolonged use and high doses. Thus, tapering GC to the minimal required dose remains a major therapeutic objective in RA management. GC sparing effects in real life practice have been demonstrated with anti-TNF agents, but only few studies have analyzed this effect with non-anti-TNF agents. The objective of this study was to investigate the impact of abatacept (ABA) on the evolution of concomitant GC dose in patients with RA
Methods:
This is a pooled observational database analysis of 9 European RA registries (ARTIS-SE, ATTRA-CZ, BIOBADASER-ES, DANBIO-DK, GISEA-IT, NOR-DMARD-NO, ORA-FR, SCQM-CH, Reuma.PT). Inclusion criteria for this analysis were a diagnosis of RA, initiation of ABA and available information on time-varying GC use. The primary endpoint was mean GC dose over time. Because GC dose was not normally distributed and there were a significant number of zeros (non GC users), we used a ‘Hurdle Model’ to analyze the longitudinal evolution of mean GC dose over time.
Results:
We identified 2409 patients initiating ABA with 5054 pt-years (PY) of follow-up with complete time-varying information on concomitant GC use. At baseline, the mean age was 58.6 years, 78% were female, and mean BMI was 26.4 kg/m2. Disease characteristics suggest long-standing RA with severe disease (mean disease duration of 13.4 yrs, DAS28 5.0, HAQ score 1.32, ESR 31 mm/h, RF positive 72%, anti-CCP positive 68%). Most patients have failed several biotherapies before starting ABA (prior N° of biotherapies: 2 [IQR: 1 – 3]) and several conventional synthetic DMARDs (prior N° of csDMARDs; 2 [IQR: 1 – 4]).
At initiation of ABA, 87.4% of patients received concomitant GCs at a mean dose of 7.8 (95% CI: 0 – 18) mg (median dose [IQR] of 6.4 [5.0 -10.0] mg) of prednisone per day. The average GC dose slowly but continuously decreased after ABA initiation at a mean rate of -0.6 mg/year per patient. After one year, 11.5% of patients had stopped concomitant GC altogether. Significant predictors of lower concomitant GC use were female sex, older age, lower baseline disease activity, and less prior biotherapy failures.
Conclusion:
Data from this Pan-European registry analysis reveals that concomitant GC use is very common in patients starting ABA, with established and severe RA and a history of multiple failures on biotherapies. The average GC dose and the proportion of patients requiring GC decreases continuously after ABA initiation, demonstrating indirectly the effectiveness of ABA in this population. GC dose reduction in patients responding to ABA may contribute to a decrease in the burden of co-morbidities.
To cite this abstract in AMA style:
Gottenberg J, Mariette X, Hernandez MV, Iannone F, Lie E, Canhão H, Pavelka K, Turesson C, Lund Hetland M, Finckh A. Glucocorticoid-Sparing Effects of Abatacept in Real Life Practice: Data from a Paneuropean Analysis of RA Registries [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/glucocorticoid-sparing-effects-of-abatacept-in-real-life-practice-data-from-a-paneuropean-analysis-of-ra-registries/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/glucocorticoid-sparing-effects-of-abatacept-in-real-life-practice-data-from-a-paneuropean-analysis-of-ra-registries/