ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 609

Multi-Biologic Usage in Rheumatoid Arthritis Is Not Infrequent in the Routine Practice

Alper Sari1, Levent Kilic1, Berkan Armagan1, Abdulsamet Erden2, Gozde Yardımcı1, Ali Akdogan2, Omer Karadag2, Sule Apras Bilgen2, Ihsan Ertenli2 and Sedat Kiraz2, 1Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey, 2Rheumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Biologic DMARDs (bDMARDs) have proven efficacy in rheumatoid arthritis (RA) however, some patients inadequately response to multiple bDMARDs.  This study aims to determine the risk factors for ≥ 2 switches between bDMARDs in RA patients.

Methods: Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a monocentric registry of bDMARDs including 1609 RA patients by May 2018. The recorded bDMARDS in HUR-BIO were anti-TNF treatments (adalimumab, etanercept, infliximab, golimumab, certalizumab), rituximab, abatacept, tocilizumab, and tofacitinib. Demographic, clinical data and baseline disease activity (DAS-28, swollen and tender joint counts (28 joints)), and functional status were assessed. Six hundred and ninety-four patients with at least 3 control visits were enrolled to analyze. Flow-chart of switching among bDMARDs was shown in Figure. Baseline demographic and clinical risk factors for ≥ 2 switches of bDMARDs were analyzed by using univariate and multivariate analyses.

Results: One hundred and fifty– eight (22.7%) patients had ≥ 2 switches between bDMARDs for any reason. Among this group, 40.5%, 39.2%, 15.1%, 3.8%, 0.6% of patients were treated with 3,4,5,6 and 7 bDMARDs, respectively. Baseline demographic, clinical and laboratory data of patients were shown in Table 1. In multivariate analysis, longer follow-up duration (OR: 1.21, 95% CI: 1.06-1.37) and rheumatoid factor (RF) negativity (OR: 2.10, 95% CI: 1.13-3.89) was found as independent risk factors for ≥ 2 switches of bDMARDs. The analyses were performed again in a subgroup of patients including patients with ≥ 2 switches due to primary or secondary inefficacy (n=85) and patients without any switches (n=336). Patients with ≥ 2 switches  were younger (46.2 (11.3) vs 49.5 (11.9), p=0.02), had  higher number of swollen joint counts (3.8 (2.5) vs 2.9 (2.5), p=0.04), and longer follow-up duration (6.3 (3.9) vs 4.0 (2.6), p<0.001). Multivariate analysis failed to demonstrate any risk factor in this subgroup.

Conclusion:  High prevalence of more than two switches among bDMARDs in our cohort implicates that there is still an unmet need in the treatment of RA patients. Multi-biologic usage of bDMARDs may be related with RF seronegativity. 

 

                      

Figure: Flow-chart of switching among bDMARDs

Disclosure: A. Sari, None; L. Kilic, None; B. Armagan, None; A. Erden, None; G. Yardımcı, None; A. Akdogan, None; O. Karadag, None; S. Apras Bilgen, None; I. Ertenli, None; S. Kiraz, None.

To cite this abstract in AMA style:

Sari A, Kilic L, Armagan B, Erden A, Yardımcı G, Akdogan A, Karadag O, Apras Bilgen S, Ertenli I, Kiraz S. Multi-Biologic Usage in Rheumatoid Arthritis Is Not Infrequent in the Routine Practice [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/multi-biologic-usage-in-rheumatoid-arthritis-is-not-infrequent-in-the-routine-practice/. Accessed .

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/multi-biologic-usage-in-rheumatoid-arthritis-is-not-infrequent-in-the-routine-practice/