Session Information
Session Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy: Safety of Biologics and Small Molecules in Rheumatoid Arthritis
Session Type: Abstract Submissions (ACR)
Background/Purpose : Tocilizumab, as an intra-venous agent, has been approved for rheumatoid arthritis (RA) in Canada in April 30th, 2010. It was the sixth approved agent after adalimumab, etanercept, abatacept, infliximab and rituximab. It has been demonstrated effective in the treatment of RA either in monotherapy or combo therapy after non-biologic or biologic DMARDS [1-3]. The goal of this analysis is to describe its effectiveness in patients with RA failing a first anti-TNF DMARDs and to compare its retention rate versus adalimumab, etanercept and infliximab in the same clinical situation.
Methods : All patients with RA having failed a first anti-TNF agents and subsequently exposed to tocilizumab after the 1stof January 2005 were extracted from the Rhumadata® database. 4 cohorts were created according to the time tocilizumab or the subsequent anti-TNF agents was introduced: One cohort of patients starting tocilizumab and 3 other cohorts starting either adalimumab, Etanercept or infliximab. Demographics and baseline characteristics including age, gender, disease duration, Rheumatoid factor and anti-CCP antibodies, CRP and ESR, previous failed treatment number, DAS 28 ESR and CDAI, HAQ-DI were included for each cohorts.
Results : The data from 259 patients prescribed either tocilizumab (53=20%), adalimumab (97=37%), etanercept (82=33%) or infliximab (27=10%) as a second biologic agent were extracted from the Rhumadata® registry and clinical database. Mosts subjects were female (75%) and the average age of cohort subjects was 58.2 (StD=14.3). Mean CRP and ESR were respectively 17.0 (StD=29.5) mg per L and 26.6 (StD=24.1) mm per hour. No clinically significant differences at baseline were observed between groups. The four year retention rates of tocilizumab, adalimumab, etanercept and infliximab as second line biologic agents were 44.3%, 27.2%, 37.1% and 34.0% respectively. Kaplan-Meier survival analysis revealed significant differences in the drug retention rates (logrank p=0.0249).
Conclusion : In RA patient having failed their first anti-TNF agent, tocilizumab, an Il-6 inhibitor, could be a more valuable alternative than cycling to a second anti-TNF agent.
References :
1. Bykerk, V.P., et al., Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice. Ann Rheum Dis, 2012. 71(12): p. 1950-4.
2. Emery, P., et al., IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis, 2008. 67(11): p. 1516-23.
3. Emery, P., Optimizing outcomes in patients with rheumatoid arthritis and an inadequate response to anti-TNF treatment. Rheumatology (Oxford), 2012. 51 Suppl 5: p. v22-30.
Disclosure:
D. Choquette,
None;
M. P. Payette,
None;
J. P. Raynauld,
None;
J. P. Pelletier,
None;
L. Bessette,
None;
E. Villeneuve,
None;
B. Haraoui,
AbbVie,
2,
AbbVie,
5,
Amgen,
2,
Amgen,
5,
Bristol-Myers Squibb,
2,
Bristol-Myers Squibb,
5,
Janssen Pharmaceutica Product, L.P.,
2,
Janssen Pharmaceutica Product, L.P.,
5,
Pfizer Inc,
2,
Pfizer Inc,
5,
Roche Pharmaceuticals,
2,
Roche Pharmaceuticals,
5,
UCB,
2,
UCB,
5;
I. Fortin,
None;
M. A. Rémillard,
None;
D. Sauvageau,
None;
L. Coupal,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tocilizumab-use-in-patients-with-rheumatoid-arthritis-having-failed-one-previous-anti-tnf-agent-comparison-with-adalimumab-etanercept-and-infliximab/