Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Although the majority of RA patients respond to treatment with anti-TNF agents, some patients present with refractory disease (1ry failure) while others show some initial clinical response and eventually lose responsiveness (2ry failure). Assessing primary and secondary failure, and thus the extent of non-response to anti-TNF agents, is complex due to the use of different definitions and variations in the timing of patient assessment in routine clinical care. The purpose of this analysis was to assess the rate of non-response based on different definitions among RA patients treated with anti-TNF in a large observational cohort.
Methods: Patients enrolled in the Ontario Best Practices Research Initiative (OBRI) that were treated with an anti-TNF agent and had available information on treatment discontinuation were included in the analysis. Those who discontinued anti-TNF due to 1ry failure, 2ry failure, or an adverse event (AE) as per the judgment of the treating physician were classified in three different types of failure, based on (i) time of failure (<6 months, 6-12 months, >12 months); (ii) response to treatment, i.e. whether they achieved DAS28 low disease activity (LDA) prior to discontinuation, and; (iii) time and response criteria. Time to treatment discontinuation and time to LDA were assessed with the Kaplan-Meier (K-M) estimator of the survival function.
953 patients (81.6% female) were included with a mean (SD) age at OBRI enrolment of 56.0 (12.5) and disease duration of 9.8 (9.5). Mean (SD) disease parameters were: DAS28: 4.6 (1.2); SJC: 6.1 (5.2); TJC: 6.8 (6.5); physician global: 4.8 (2.5) cm; patient global: 5.2 (2.7) cm.
After a mean (SD) follow-up of 32.8 (30.6) months, 259 (27.2%) patients were discontinued due to some type of failure; 187 (19.6%) due to non-response and 72 (7.6%) due to safety reasons with mean (SD) K-M-based time to failure of 9.3 (0.4) years. Table 1 summarizes the incidence of each type of failure by type of definition. Among patients failing anti-TNF treatment after 12 months half achieved DAS28 LDA before failure after a median of 37 months.
Conclusion: The results of this analysis have shown that the rate of primary failure to anti-TNF treatment may range from 6% to 15% depending on the failure definition used highlighting the need for standardization. Furthermore, approximately half of the patients showing some initial clinical response can achieve LDA over a 3-year period.
To cite this abstract in AMA style:Keystone EC, Movahedi M, Cesta A, Li X, Couto S, Rampakakis E, Sampalis JS, Bombardier C. What Is the Rate of Primary and Secondary Failure of Anti-TNF in RA Patients? Data from a Rheumatoid Arthritis Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/what-is-the-rate-of-primary-and-secondary-failure-of-anti-tnf-in-ra-patients-data-from-a-rheumatoid-arthritis-cohort/. Accessed January 20, 2019.
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