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Biologic Discontinuation Rates Increased During the Past Decade
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WASHINGTON — As more biologics have come to market during the last decade, biologic discontinuation rates among patients with rheumatoid arthritis have increased and discontinuation rates for these drugs have become more comparable, according to a poster presentation at the American College of Rheumatology Annual Meeting.
“Our poster summarizes drug discontinuation rates of several biologics, as a measure of effectiveness, comparing it by mechanism of action, route of administration, line of treatment and prior drug use, such as [tumor necrosis factor] TNF or concomitant use of [methotrexate] MTX or prednisone,” Sofia Pedro, MD, at the National Data Bank for Rheumatic Diseases in Kansas, told Healio Rheumatology. “Discontinuation tends to be similar when comparing individual biologics or by most of the variables used. This is a reflection of the several medical options patients have.”
Pedro and colleagues characterized patients with rheumatoid arthritis who initiated a biologic between 2005 and 2015. Overall, 2,458 patients began tumor necrosis factor inhibitors (TNFis) and 1,349 patients initiated non-TNFis. The TNFi group had 6,326.5 years of follow-up, and the non-TNFi group had 2,987.5 years of follow-up. Researchers also included tofacitinib as a non-TNFi. For the Kaplan-Meier survival curves, researchers defined discontinuation as either cessation of the drug or addition of another disease-modifying antirheumatic drug (DMARD). For the sensitivity analyses, they defined discontinuation only as drug cessation.
Overall, the median discontinuation time was 1.5 years for TNFi and 2 years for non-TNFi. In the sensitivity analysis, the discontinuation was 4 years for both treatments. By route of administration, the discontinuation was 3 years for oral and 1.5 years for both intravenous and subcutaneous treatments. For different lines of treatment, the discontinuation was 3.5 years for first-line TNFi; 2.5 years for first-line non-TNFi; 4 years for second-line treatment; and 3.5 years for third-line treatment.
For patients with prior TNFi use, the discontinuation was 1.5 years for TNFi and 0.5 years for non-TNFi. For patients with prior non-TNFi use, the discontinuation was 1 year for TNFi and 2 years for non-TNFi. Without concomitant MTX, the rates became 8.5 years for TNFi and 6 years for non-TNFi.
This decline without concomitant MTX was a surprising finding and is an area for further investigation, the researchers wrote.
“Patients tend to stay longer on subcutaneous biologics and surprisingly, discontinuation was lower when biologics were taken [with] MTX,” Pedro said. – by Will Offit
Reference:
Pedro S, et al. Abstract #2249. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.
Disclosure: The researchers report no relevant financial disclosures.