Session Type: Abstract Submissions (ACR)
Background/Purpose: The best treatment option after a patient has failed a first TNFi is still unknown. Therefore the objective of this randomized open label study is to compare the effectiveness of abatacept, rituximab or another TNFi after failing a first TNFi, with the DAS28 as outcome measure, in patients with Rheumatoid Arthritis.
Methods: The inclusion criteria for this pragmatic randomized trial within the DREAM cohort were: failing a first TNFi, a DAS28 > 3.2, not treated before with abatacept or rituximab and no contraindications. Patients were randomized to abatacept, rituximab or TNFi treatment. The DAS28 was compared between the three groups with ANOVA, 6 and 12 month after randomization.
Results: 143 patients were randomized into one of the treatments (mean age 56.5 yrs, 76.5% female, median disease duration 5.85 yrs, 63.6% rheumatoid factor positive, mean DAS28 of 4.9). The mean DAS28 (+95% Confidence Interval) after 6 and 12 months respectively was 4.1 (3.7-4.6) and 3.7 (3.2-4.2) for abatacept, 3.6 (3.2-4.1) and 3.5 (3.0-3.9) for rituximab and 3.8 (3.3-4.3) and 3.5 (2.9-4.1) for TNFi, see figure. These were not statistically significant. Remission (DAS28<2.6) was attained in 10.7% and 12.0% in the abatacept group, 24.3% and 27.3% in the rituximab group and 12.9% and 24.1% in the TNFi group at 6 and 12 month respectively.
Conclusion: The data do not reveal a significant difference in effectiveness, measured with the DAS28, between the three different biological. Therefore other reasons than DAS28 status at 6 and 12 months might play a more important role in the choice of a second biological like long term stability of response, side effects, costs or patients preferences for route of administration of treatments.
S. H. M. Manders,
H. L. M. Brus,
H. J. Bernelot Moens,
H. E. Vonkeman,
M. A. F. J. van de Laar,
P. L. Van Riel,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mode-of-action-change-not-necessary-after-failing-the-first-tumornecrosisfactor-inhibitor-preliminary-results-of-a-randomized-controlled-trial/