Head-to-Head Comparison of the Retention Rate of First Biologics in Elderly Patients with Rheumatoid Arthritis in Japanese Clinical Practice: Results from the Multicenter Biologic Registry

Masatoshi Hayashi¹, Toshihisa Kanamono², Hiroyuki Matsubara³, Toshihisa Kojima⁴, Koji Funahashi⁵, Nobunori Takahashi⁴ and Naoki Ishiguro⁶, ¹Departments of Orthopedic surgery and Rheumatology, Nagano Red Cross Hospital, Nagano, Japan, ²Reumatology, Nagano Red Cross Hospital, Nagano, Japan, ³Department of Orthopedic Surgery and Rheumatology, Nagano Red Cross Hospital, Nagano, Japan, ⁴Department of Orthopedic Surgery, Nagoya University Hospital, Nagoya, Japan, ⁵Nagoya University, Nagoya, Japan, ⁶Department of Orthopedic Suregery, Nagoya University Hospital, Nagoya, Japan

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Abatacept and rheumatoid arthritis (RA), Biologic agents, Elderly

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: The objective of this report was to clarify and compare the retention rate of first biologics used to treat elderly Japanese patients with rheumatoid arthritis (RA).

Methods: A prospective analysis was performed on 289 patients of age over 65 years with RA followed up in our multicenter registry after September 2010 (approval date of abatacept as the 5^th biologic agent for RA, two years after tocilizumab in Japan). We assessed the age, sex, disease duration, Steinblocker’s Stage and Class, Disease Activity Score 28-Erythrocyte Sedimentation Rate, past operation history, complications, methotrexate use and dose, and corticosteroid use and dose as baseline characteristics, and compared cumulative survival and reasons of discontinuation among patients treated with the TNF-inhibitors (TNF-i), abatacept, and tocilizumab.

Results: Of the 289 patients, 146 (50.5%) were treated with TNF-i, 117 (40.5%) with abatacept, and 26 (9.0%) with tocilizumab. The patients in the abatacept group had older age and longer disease duration, worse stage and class, fewer complications, and lower methotrexate use than those in the TNF-i group (see table). However, the cumulative survival was longer in the abatacept group than in the TNF-i group (P = 0.013, log-rank test).

Conclusion: In our cohort of elderly patients with RA, the abatacept group, despite a relatively worse RA presentation at baseline, had better retention rate compared with the TNF-i group. This result provides valuable information in managing active RA in elderly patients.

Table. Demographic and clinical characteristics of patients of age over 65 years with rheumatoid arthritis who received first biologic treatments after September 2010
Characteristics	Total	TNF-i	Abatacept	Tocilizumab	P-value†
Number (%)	289 (100)	146 (50.3)	117 (40.3)	26 (9.0)
Age, years	72.17 ± 5.26	71.08 ± 4.95	73.80 ± 5.33	70.96 ± 4.85	<0.001*
Female, %	77	81	79	50	0.757
RA disease duration, years	10.84 ± 11.12	9.30 ± 9.84	13.50 ± 12.75	8.58 ± 8.73	0.014*
Steinblocker’s Stage III or IV, %	59	51	69	52	0.010*
Steinblocker’s Class 3 or 4, %	38	26	56	24	<0.001*
DAS28ESR	5.20 ± 1.21	5.08 ± 1.19	5.23 ± 1.27	5.71 ± 1.00	0.360
Past operations, %	17	22	15	9	0.226
Complications, %	66	71	53	83	0.043*
MTX use, %	62	77	44	72	<0.001*
MTX dose, mg/week	8.32 ± 3.22	8.58 ± 3.06	7.72 ± 3.51	8.56 ± 3.20	0.091
Oral corticosteroids use, %	54	56	53	50	0.695
PSL-equivalent dose, mg/day	4.87 ± 2.74	4.90 ± 2.88	4.73 ± 2.75	5.42 ± 1.79	0.895
AE as reason of discontinuation, no. (%)	81 (37)	52 (31)	22 (41)	7 (71)	0.430
The data are reported as mean ± standard deviation. †P-values are calculated between TNF-i and abatacept with suitable statistics. RA rheumatoid arthritis, TNF-i tumor necrosis factor inhibitor, DAS disease activity score, ESR erythrocyte sedimentation rate, MTX methotrexate, PSL prednisolone, AE adverse events

Disclosure: M. Hayashi, None; T. Kanamono, None; H. Matsubara, None; T. Kojima, Takeda Pharma Corporation, 2,Janssen Pharmaceutical, 2,Astellas Pharma Corporation, 2,Mitsubishi Tanabe Pharma Corporation, 8,Takeda Pharma Corporation, 8,Eisai Pharma Corporation, 8; K. Funahashi, Abbvie Japan Co. Ltd, 8,Eisai Co. Ltd, 8,UCB Japan Co. Ltd, 8,Mitsubishi Tanabe Pharma Co., 8,Takeda pharmaceutical Co. Ltd, 8,Pfizer Co. Ltd, 8,Chugai Pharma Co. Ltd, 8,Janssen Pharma KK, 8,Bristol-Myers Squibb, 8; N. Takahashi, None; N. Ishiguro, Takeda, Mitsubishi-Tanabe, Astellas, Chugai, Abbott, Bristol-Myers Squibb, Eisai, Janssen, Kaken, Pfizer, 2,Takeda, Mitsubishi-Tanabe, Astellas, Chugai, Abbott, Bristol-Myers Squibb, Eisai, Janssen, Kaken, Pfizer, Taisho-Toyama, Otsuka, 8.

To cite this abstract in AMA style:

Hayashi M, Kanamono T, Matsubara H, Kojima T, Funahashi K, Takahashi N, Ishiguro N. Head-to-Head Comparison of the Retention Rate of First Biologics in Elderly Patients with Rheumatoid Arthritis in Japanese Clinical Practice: Results from the Multicenter Biologic Registry [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/head-to-head-comparison-of-the-retention-rate-of-first-biologics-in-elderly-patients-with-rheumatoid-arthritis-in-japanese-clinical-practice-results-from-the-multicenter-biologic-registry/. Accessed .

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