Abatacept Linked to Major Clinical RA Response in Men, Biologic-naive
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Among patients with rheumatoid arthritis, men and those with no prior history of receiving biologic DMARDs are more likely to remain on abatacept with a major clinical response, according to data published in Arthritis Research & Therapy.
“There is limited data on abatacept efficacy and on predictors of clinical response in real-world as derived from a single national register,” Giovanni Cagnotto, a doctorate student at Lund University, in Sweden, and colleagues wrote. “Most studies are based on pooled data from several registers or multicenter studies from several countries. Such studies may be affected by patient heterogeneity and differences in access to [biologic] DMARDs.”
To examine the clinical efficacy and tolerability of abatacept (Orencia, Bristol-Myers Squibb) among patients with RA, Cagnotto and colleagues conducted an observations study of data from the Swedish Rheumatology Quality register. According to the researchers, the register is a nationwide database of patients in Sweden with inflammatory joint diseases. For their study, Cagnotto and colleagues included 2,716 patients with RA registered in the database who started abatacept between April 2006 and November 2017.
The researchers evaluated survival on the drug using Kaplan-Meier analysis. Drug response was measured using EULAR good response and health assessment questionnaire (HAQ) response rates — defined as an improvement of 0.3 or greater — at 6 and 12 months. Cagnotto and colleagues evaluated predictors for discontinuation using Cox regression analyses, as well as predictors for clinical response through logistic regression. In addition, they used significance-based backward stepwise selection of variables for the final multivariate models.
According to the researchers, there was a significant difference in drug survival based on whether the patients had previously received biologic DMARDs (P<.001), with longer survival demonstrated in those who were naive to the treatment. In addition, men (HR = 0.86; 95% CI, 0.74-0.98) and those taking methotrexate (HR = 0.85; 95% CI, 0.76-0.95) were less likely to discontinue abatacept. A high pain score predicted discontinuation (HR = 1.14; 95% CI, 1.07-1.2).
Patients who were biologic DMARD-naive, male and had a low HAQ score were independently associated with a EULAR good response, while the lack of previous biologic DMARDs also predicted HAQ response.
“The analysis of one of the largest cohorts of abatacept-treated RA patients gave insights on the differences between bionaive and [biologic] DMARD experienced patients in term of treatment persistency as well as in terms of clinical and functional response,” Cagnotto and colleagues wrote. “We demonstrated that bionaive patients had longer survival on abatacept as well as better clinical and functional response to this drug as compared to [biologic] DMARD experienced patients.”
“Sex, and to some extent baseline disease severity, also influenced outcome of treatment with abatacept,” they added. “Insights on the efficacy and tolerability of abatacept based on such data from a real-life setting may be useful for clinical practice.” – by Jason Laday
Disclosure: Cagnotto reports consulting fees from Novartis. Please see the study for all other authors’ relevant financial disclosures.
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