No difference in outcomes for interleukin-6, TNF inhibitors among RA patients
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In patients with rheumatoid arthritis, there was no significant difference in outcomes for interleukin-6 and TNF inhibitors, according to a presentation at ACR Convergence 2021.
“There is limited research comparing the effectiveness of [TNF inhibitors (TNFi) and IL-6 receptor inhibitors (IL-6Ri)] in biologic-experienced patients,” Anthony Sebba, MD, of University of South Florida’s division of rheumatology, said in the presentation. “Using data from the CorEvitas’ RA registry, we conducted a real-world retrospective study among biologic-experienced RA patients with moderate or high disease activity to compare the effectiveness of TNFi versus IL-6Ri in combination with [conventional synthetic (cs) disease-modifying antirheumatic drugs] or as monotherapy in reducing disease burden and disease activity.”
The researchers reviewed data for adult patients with RA who began TNF inhibitor or IL-6 receptor inhibitor as monotherapy or in combination with csDMARDs during or after January 2010. All patients had previous experience with biologic or targeted synthetic DMARDs and attended follow-up at 6 months.
Among the 286 patients beginning IL-6 and 737 starting TNF monotherapy, those on IL-6 were older, had a longer history of RA, a higher baseline Clinical Disease Activity Index (CDAI) and were more likely to start IL-6 as a third line therapy. In the combination therapy cohort, 401 patients started IL-6 while 1,315 patients began TNF. Those on IL-6 had higher baseline CDAI and were more likely to start as third-line therapy compared with patients on TNF.
There were no significant differences in disease burden, non-inflammatory pain and CDAI score between patients on IL-6 and TNF as a monotherapy or combination therapy. Low disease activity was achieved in one-third of patients on monotherapy (adjusted OR =0.99; 95% CI, 0.59-1.67) and combination therapy (aOR = 0.96; 95% CI, 0.66-1.38).
According to Sebba, the reduced difference in effectiveness observed between IL-6 and TNF treatments may have been impacted by many factors, including patients’ age, disease duration, prior experience with biologics and LDA, as well as the study being unblinded to both patients and physicians.
“Additional differences such as possible variable adherence to therapy, less strict follow-up, and beliefs and expectations of patients and physicians in real life may influence evaluation of disease activity after therapy,” he said during the presentation. “RCTs where these factors can be controlled may provide more insight into the comparison of these therapies in a biologic-experienced population, although they may not represent the real-world practice.”
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Sebba A. Abstract 0834. Presented at: ACR Convergence 2021; November 3-10, 2021 (virtual meeting).
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