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Patients with RA, prior biologic therapy less likely to respond to Humira
Patients with rheumatoid arthritis, especially older patients with a longer disease duration, who had a prior history of biological therapy were less likely to respond to Humira than patients who had no history or one prior treatment with a biologic agent, according to researchers in Germany.
An analysis of 4,700 patients with rheumatoid arthritis (RA) treated with Humira (adalimumab, AbbVie) between June 2003 and March 2009 was conducted. No prior use of biologic therapy was present in 3,213 patients, one prior biologic treatment was used in 1,149 patients and two or more prior biologic therapies had been attempted by 336 of the patients. About half of the patients were administered methotrexate concomitantly at baseline. About 20% received concomitant leflunomide, and 26.8% received adalimumab as monotherapy at baseline.
Patients were assessed for disease activity in 28 joints (DAS28), inflammatory markers and the Funktionsfragebogen Hannover (FFbH) functional ability score, a validated assessment comparable to the Health Assessment Questionnaire-Disability Index (HADS-DI).
After 12 months of follow-up, data were available for 2,750 patients, including 1,926 patients with no prior biologic history, 661 patients with one prior biologic treatment and 163 patients with two or more prior biologic treatment attempts.
Discontinuation rates between patients with no prior treatment (22.3%) and one prior treatment (22.4%) were similar; however, rates were higher in the group with two or more attempted biologic therapies (29%), particularly for lack of efficacy (17.8%) compared with patients with no biologic treatment (11.7%) or one biologic treatment (12.2%) previously.
Multiple regression analysis showed the number of prior biologic treatments was significantly associated with lack of improvement in DAS28, FFbH or inflammatory markers, and that patients with the best response rates were more likely to have had no prior biologic intervention, regardless of methotrexate use.
By month 12, remission was achieved in 22.1% of patients with no prior biologic use vs. 14.2% of patients with history of one prior biologic treatment and in 9% of patients with two or more prior treatments, according to the researchers.
Sixteen patients achieved remission at 3 months, and analysis results revealed these patients were significantly younger (39.6 years vs. 54 years for patients not in remission), younger at mean disease onset (27.5 years vs. 40.5 years) and were more likely to be men (37.5% vs. 22%), although disease duration was similar between groups. Patients who achieved remission also had lower DAS28, better FFbH scores, fewer active joints and lower counts of inflammatory markers at baseline. - by Shirley Pulawski
Disclosure: The researchers report funding for the study, data analysis and manuscript support were provided by AbbVie Deutschland GmbH & Co.