Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Eight biologics have been approved for rheumatoid arthritis (RA) in Japan. However, little is known regarding what to do when patients have an inadequate response to first biologics in daily clinical practice. This study aimed to evaluate the effectiveness of biologics as 2nd-line use in RA patients in daily clinical practice from our university cohort (FIRST registry).
Methods: We retrospectively examined more than 2500 patients who were treated with biologics in our institute between July 2003 and December 2015. We compared the effectiveness of TNF-inhibitors (TNFi), TCZ, ABA as 2nd-line use and efficacy of switching from 1st TNFi to 2nd TNFi, TCZ or ABA based on CDAI and biomarkers such as CRP, ESR and MMP3, IL-6 (LOCF). Propensity score (PS) were generated using multinomial logistic regression and the study groups were matched regarding baseline variables including age, disease duration, disease activity, concomitant use of MTX and PSL. In addition, in order to find out the characteristic of 2nd biologics, we conducted comparison between the upper (1yCDAI-H; low response) and lower (1yCDAI-L; good response) quartiles in CDAI at 1 y after switching.
Results: In terms of switching of biologics, CDAI at 1year was comparable among TCZ(n=141), 2ndTNFi（n=186）and ABT(n=91) after the adjustment by PS. Interestingly, comparison between the upper (1yCDAI-H) and lower (1yCDAI-L) quartiles in CDAI at 1 y after switching revealed that disease activity might improve despite of a high disease activity at switching in the case of TCZ. In addition, higher CRP, MMP-3 at switching were predictive factors for better outcome despite of higher RF factor in the case of switching to TCZ. Titer of Serum IL-6 but not TNF was markedly elevated in patients showed better outcome. In contrast, ABT showed a lower efficacy especially in the patients with RF low, CRP high. (Figure).
Conclusion: After adjustment using PS-score, RA patients with prior anti-TNF exposures had similar outcomes after switching. Our results imply us that CRP, MMP3 and RF titer at switching gives us important information for switching. Of note, higher CRP or MMP-3, suggesting inadequate suppression of IL-6 by first biologics, might predict better outcome of TCZ.
To cite this abstract in AMA style:Saito K, Nakano K, Nakayamada S, Kubo S, Miyagawa I, Iwata S, Tanaka Y. Predictive Factors for Better Outcome of Switching of Biologics for Patients with Rheumatoid Arthritis in Daily Clinical Practice [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/predictive-factors-for-better-outcome-of-switching-of-biologics-for-patients-with-rheumatoid-arthritis-in-daily-clinical-practice/. Accessed December 13, 2019.
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