Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Data are very limited concerning the association between cotreatment with a conventional synthetic DMARD (csDMARD) and long term retention of abatacept (ABA), rituximab (RTX) and tocilizumab (TCZ) in real life.
Methods: This was a pre-specified sub-group analysis of a multicenter open-label observational study of patients with RA according to 1987 ACR criteria who initiated RTX, ABA, or TCZ and were enrolled in 3 French Society of Rheumatology prospective registries (AIR for rituximab, ORA for abatacept, and REGATE for tocilizumab). We used a propensity-score approach to adjust for differences in observed factors that might affect both treatment assignment and outcome.
Results: Data on concomitant treatment were available in 4469 out of 4498 patients (99.6%). 34.9, 34.3 and 40.2% of patients respectively treated with ABA, RTX and TCZ, initiated their biologic in monotherapy. 79.5% of patients with a csDMARD received methotrexate. 3507 patients had a follow-up at 24 months for a total follow-up of 18898 patient-years (RTX: 10545; ABA: 4912; TCZ: 3441). – Effect of concomitant csDMARD on the effectiveness of each drug Drug retention without failure of RTX at 2 years was 67.8[65.2; 70.4]% in patients treated in combination with a csDMARD and 65.1 [61.5;68.8]% in monotherapy, HR of discontinuation 0.89 [0.76;1.05], p= 0.21. Drug retention without failure of RTX at 5 years was 50.1[47.4; 53.0]% in combination and 45.3 [41.5;49.4]% in monotherapy, HR of discontinuation of 0.88 [0.77;1.0], p= 0.08. Drug retention without failure of ABA at 2 years was 42.6[38.9; 46.7]% in patients treated in combination and 36.7 [31.9;42.2]% in monotherapy, HR of discontinuation 0.86 [0.73;1.01], p= 0.08. Drug retention without failure of ABA at 5 years was 22.8[19.7; 26.4]% in combination and 18.7 [15;23.5]% in monotherapy, HR of discontinuation of 0.87 [0.75;1.01], p= 0.07. Drug retention without failure of TCZ at 2 years was 66.1 [62.9; 69.6]% in patients treated in combination and 60.9 [56.8;65.4]% in monotherapy, HR of discontinuation 0.82 [0.66;1.02], p= 0.09. – Effect of concomitant csDMARD on the comparative effectiveness between ABA, RTX and TCZ At 2 years, drug retention without failure among patients treated in combination with a csDMARD was significantly greater with RTX and TCZ than ABA (hazard ratio 1.85 [95% CI: 1.52;2.26], and 1.83 [95% CI: 1.39;2·42], respectively), with no difference between RTX and TCZ. At 2 years, drug retention without failure among patients treated in monotherapy was significantly greater with RTX and TCZ than ABA (HR 2.29 [95% CI: 1.62;3.25], and 1.84 [95% CI: 1.15;2·96], respectively), with no difference between RTX and TCZ. At 5 years, drug retention without failure among patients treated in combination was significantly greater with RTX than ABA (HR 1.94 [95% CI: 1.64;2·29], and it was the same for patients treated in monotherapy (HR 2.31 [95% CI: 1.22;2·42]).
Conclusion: In real life patients, monotherapy with abatacept, rituximab or tocilizumab is not associated with a lower long term retention than combination with synthetic DMARD.
To cite this abstract in AMA style:Gottenberg JE, Morel J, Constantin A, Bardin T, Cantagrel AG, Combe B, Dougados M, Flipo RM, Saraux A, Schaeverbeke T, Sibilia J, Soubrier M, Vittecoq O, Perrodeau E, Ravaud P, Mariette X. Monotherapy with Abatacept, Rituximab or Tocilizumab Is Not Associated with a Significantly Lower Long Term Retention Than Combination with Synthetic DMARD: Long-Term Registry Data in 4498 Real-Life Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/monotherapy-with-abatacept-rituximab-or-tocilizumab-is-not-associated-with-a-significantly-lower-long-term-retention-than-combination-with-synthetic-dmard-long-term-registry-data-in-4498-real-life-p/. Accessed October 27, 2020.
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