Artikel
Two-year retention and effectiveness of IV abatacept monotherapy and combination in patients with RA previously treated with at least one biologic agent in a real-life setting: subgroup analysis from the ACTION study
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Veröffentlicht: | 12. September 2014 |
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Gliederung
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Background: Although biologic agents should be preferentially used in combination with MTX or other conventional synthetic (cs)DMARDs [1], biologic monotherapy may be considered, especially if there is an intolerance to csDMARDs. We assessed retention rates and the effectiveness of IV abatacept as monotherapy or in combination with csDMARDs (±MTX) over 2 years in the real-world ACTION study.
Methods: ACTION is a 2-year, international, non-interventional cohort of RA patients who initiated IV abatacept between May 2008 and January 2011. Crude abatacept retention rates were estimated using the Kaplan–Meier method. Patients who failed ≥1 biologic agent were grouped by treatment pattern at abatacept initiation (monotherapy vs combination [±MTX]). The proportion of patients achieving a moderate/good EULAR response was assessed at 24 months (as observed).
Results: Of 1131 evaluable patients, 1009 (89.2%) had failed ≥1 biologic agent. Abatacept was initiated in combination with csDMARDs in 772/1009 (76.5%) patients (MTX in 569/1009 [56.4%]) and as monotherapy in 237/1009 (23.5%). Compared with combination, patients in the monotherapy group were older (mean [SD]: 59.1 [12.5] vs 55.3 [12.2] years), had longer disease duration (13.9 [10.6] vs 11.2 [8.7] years), more comorbidities (77.2 vs 70.6%) and had failed a higher number of anti-TNFs (57.4 vs 47.7% failed ≥2 previous anti-TNFs). Previous MTX was discontinued due to intolerance in 68.1% of monotherapy patients. Overall, 161/237 (67.9%) patients were receiving a biologic monotherapy when they switched to abatacept. Retention rates at 24 months were similar for the combination and monotherapy groups (Figure 1 [Fig. 1]). A good/moderate EULAR response was achieved in 80.6% (n=222) and 78.8% (n=61) of patients in the combination and monotherapy groups, respectively. Safety and tolerability are reported elsewhere and were consistent with previously published data [2].
Conclusion: Over 24 months in a real-life setting, good retention rates were observed with IV abatacept in patients refractory to previous biologic therapy. Retention rates were similar when abatacept was initiated in combination with csDMARDs or with concomitant MTX. Retention rates with abatacept monotherapy were similar to combination therapy, although monotherapy patients had more comorbidities and most were intolerant to MTX, supporting monotherapy use in these patients.
References
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