Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Evaluate the survival of the 2nd biological disease modifying drug (bDMARD)
and to determine the causes of suspension of the 2nd bDMARD.
Methods: Patients ≥ 18 years of age who met ACR/EULAR 2010 criteria for Rheumatoid
Arthritis (RA) and who had started their first biological disease modifying antirheumatic
drug (bDMARD) between 01/2006 and 12/2017 were included. Socio-demographic variables,
comorbidities, smoking status, date of onset of symptoms, the time elapsed between
the interruption of the first bDMARD and the start of the second and the response
to it. Variables were compared with Chi2, Student’s T test and ANOVA. Cumulative survival
was evaluated using Kaplan Meier curves and their comparisons using log rank.
Results: 347 patients were included, with a median age of 57.8 years (IQR: 48-65),
89.6% were women, 96.5% had positive RF and 60.8% positive anti-CCP. 70.6% had health
coverage, 16.3% were smokers and 51.2% had comorbidities. 53.9% discontinued the 1st
bDMARD of which 27.6% started a 2nd one (Abatacept 41.2 %, Etarnecept 25%, Adalimumab
16.7%, Tocilizumab 14.6%, Certolizumab 6.3% and Rituximab 1%). The mean time
between 1st bDMARD discontinuation and inititation of the 2nd was 9.5 months. 41.3%
discontinued the 2nd bDMARD, being the causes of discontinuation: inefficacy 35.9%,
lack of provision 30.8% and adverse events (AE) 20.5%. The median survival time of the
2nd bDMARD was 11 months (95% CI: 4-17.9), with no significant difference between the
different drugs. In patients who had a TNF inhibitor agent as 1st bDMARD and the cause
of discontinuation was lack of provision, 86.9% of them restarted a TNF inhibitor, while a
change in mechanism of action was prefered in patients who discontinued due to AE
(69.2%) or due to inefficacy (77.7%). There was no difference in the survival of the 2nd
bDMARD to its use in monotherapy or combined with csDMARD. When the cause of suspension
of the 1st bDMARD was AE, the survival of the 2nd bDMARD was significantly lower
(mean: 3.6 months) compared to those who stopped the 1st bDMARD due to inefficiency
(mean 21.5 months) or due to lack of provision (mean:20.5 months), (Log Rank
test: p = 0.03).
Conclusion: The survival of the 2nd bDMARD was 11 months, with no differences between
drugs. The most frequent cause of suspension of treatment was inefficacy. The
only factor associated to a decreased survival of the 2nd bDMARD was the discontinuation
of the 1st bDMARD due to adverse event.
To cite this abstract in AMA style:Rolon Campuzano R, Coronel Ale AL, Cerda O, Dal Pra F, Schneeberger EE, Correa MDLA, Rosemffet MG, Buschiazzo E, García Salinas R, Papasidero SB, Barrios B, Maldonado Ficco H, Citera G. Patterns of Change of a Second Biological Dmard in a Cohort of Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/patterns-of-change-of-a-second-biological-dmard-in-a-cohort-of-patients-with-rheumatoid-arthritis/. Accessed September 21, 2021.
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