Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The order of use of biologic agents after failing a TNF inhibitor is still a question for debate. Phase III trial data in TNF-IR patients show comparable efficacy results across biologic agents and limited head-to-head studies have been published. Prospective registries offer a unique opportunity to observe the effectiveness (combined evaluation of efficacy and safety profile over time) of these agents in a real world clinical setting where all patients with a specific diagnosis and treated in the center are included. We report here a sixth year follow-up analysis. Our aim is to evaluate if patients with rheumatoid arthritis (RA) treated with rituximab (RIT) after failing a first or a second anti-TNF agents (TNF-IR) have different six-year retention rate than patients similarly prescribed anti-TNF agents (pooled adalimumab, etanercept or infliximab) and compare the treatment strategies of using RIT as second or third biologic treatment .
Methods: Data from TNF-IR RA patients prescribed adalimumab (ADA), etanercept (ETA), infliximab (INF) or rituximab (RIT) as second or third biologic agents on or after January 1st2007 was extracted and subjects taking either ADA, ETA or INF were pooled to form the anti-TNF cohort. Baseline demographics included age, disease duration, HAQ-DI, fatigue and pain visual analog scale evaluations (VAS), TJC, SJC, DAS 28 ESR and SDAI. Six-year drug retention rates were estimated and compared using Kaplan-Meier survival estimates. Statistical analysis was performed using SAS version 9.3. RHUMADATA® is a clinical database and registry used in daily clinical practice at the IRRM and CORQ. All patients with RA are followed over time irrespective of their treatment.
Results: The data from 231 RA patients were extracted, 155 and 76 having respectively failed a first and a second anti-TNF agent. No clinically significant differences in baseline variables were observed between treatment groups in second and third intention. The 6 year retention rates of second line RIT and anti-TNF use were 80.1% and 19.1% respectively (Log-rank p< 0.0001). In patients having failed two anti-TNF, subsequent use of RIT and anti-TNF agents respectively demonstrated 6 year retention rates of 53.6% and 37.2% (Log-rank p=0.0473). Second versus third line use was numerically (80.1% vs 53.6%) and statistically superior (Log-rank p=0.0029).
As second and third line agent, in TNF-IR RA patients, RIT demonstrates a better 6 year retention rate than anti-TNF agents. Second line use demonstrated a statistically better retention rate than third line use. This suggest that using rituximab as a second agent after failing a first anti-TNF agent is a better strategy than waiting to use it after two different anti-TNF failure.
To cite this abstract in AMA style:Choquette D, Bessette L, Haraoui B, Massicotte F, Pelletier JP, Raynauld JP, Rémillard MA, Sauvageau D, Villeneuve , Coupal L, Brown J, Turcotte A. Use of Rituximab Compared to Anti-TNF Agents As Second and Third Line Therapy in Patients with Rheumatoid Arthritis: 6-Year Follow-up Report from the Rhumadata® Clinical Database and Registry [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/use-of-rituximab-compared-to-anti-tnf-agents-as-second-and-third-line-therapy-in-patients-with-rheumatoid-arthritis-6-year-follow-up-report-from-the-rhumadata-clinical-database-and-registry/. Accessed July 23, 2019.
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