Background/Purpose:

Rheumatoid arthritis (RA) patients who have failed an anti-TNF agent as their first biologic agent have the option of switching to a second aTNF agent or a biologic with other mechanism of action (oMOA), either abatacept, tocilizumab,or rituximab.  An exploratory analysis was undertaken to compare the routine assessment of patient index data 3 (RAPID3) response of aTNFs vs. biologics with oMOA used as a second biologic in RA patients with a history of aTNF treatment as their first biologic DMARD.

Methods:

An observational, non-interventional, retrospective chart review study was conducted in 8 community-based rheumatology practices in the United States from February to September 2012.  Patient charts were eligible if the patient’s first biologic DMARD was an aTNF; they were 18 years or older at time of the second DMARD; they were prescribed a second biologic DMARD during the period July 1, 2006 and October 1, 2011. Patients were also required to have a RAPID3 score at baseline (up to 6 weeks prior to the second DMARD start) and at 6 months on therapy (+/-8 weeks). The RAPID3 score ranges from 0 to 30 with higher scores indicating more severe disease.  A poor response was defined as a decrease of <1.8 points and/or a follow-up score >12.   In addition, if a patient discontinued therapy prior to 6 months they were classified as having a poor response. A good response was a decrease in RAPID3 score >3.6 points and a follow-up score <6. The remainder of the patients had a moderate response.  The percent of patients with a good response and a poor response was compared between treatment groups using the chi-square test and mean change in RAPID3 by t-test.

Results:

A total of 144 charts were available for this analysis (mean age = 59.9 years, 76% female).  The second biologic DMARD was an aTNF for 101 patients and oMOA for 43 patients.  At baseline, mean scores were similar (14.8±6.2 for aTNF and 15.2±6.0 for oMOA, p=0.74).  A good RAPID3 response was achieved for 9.9% of aTNF patients and 18.6% of other MOA patients (p=0.15).  In addition, aTNF patients had a greater percent with a poor response (69.3% vs. 46.5%, p=.01). The mean change from baseline to 6 months was also different between the two treatment groups: -1.1±5.9 for aTNF vs. -4.6±5.2 for oMOA (p<.01).  These results were similar for the third biologic DMARD.

Conclusion:

In this exploratory analysis of RA patients who had discontinued their first aTNF agent, those receiving a second biologic DMARD with another MOA were more likely to have a good or moderate RAPID3 response and had a greater decrease in RAPID3 scores, compared with patients receiving a second aTNF.   We did not examine RAPID3 response to individual treatments due to small numbers.   In patients who have already failed an aTNF agent, physicians should consider using a biologic agent with a different mechanism of action.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/response-to-biologic-disease-modifying-anti-rheumatic-drugs-after-discontinuation-of-anti-tumor-necrosis-factor-alpha-agents-in-rheumatoid-arthritis-patients/