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42. Kongress der Deutschen Gesellschaft für Rheumatologie, 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 24. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

17.-20. September 2014, Düsseldorf

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Decreased use of glucocorticoids in patients with RA who initiated IV abatacept and previously failed at least one biologic agent: Results from the 2-year ACTION study

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  • Rieke H.-E. Alten - Schlossparkklinik, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Innere Medizin II, Rheumatologie, klinische Immunologie und Osteologie, Berlin
  • Hubert G. Nüßlein - Rheumatologische Schwerpunktpraxis, Nürnberg
  • M. Galeazzi - University of Siena, Siena, Italy
  • Hanns-Martin Lorenz - Universitätsklinikum Heidelberg, Medizinische Klinik V, Sektion Rheumatologie, Heidelberg
  • M.T. Nurmohamed - VU Univ Medical Center/Jan van Breeman Research Institute, Amsterdam, The Netherlands
  • William G. Bensen - St. Joseph's Hospital/McMaster University, Division of Rheumatology, Hamilton, Canada
  • Gerd-Rüdiger Burmester - Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
  • Hans-Hartmut Peter - Universitätsklinikum Freiburg, Rheumatologie und Klinische Immunologie, Freiburg i. Br.
  • Karel Pavelka - Charles University, Institute of Rheumatology and Clinic of Rheumatology, Prague, Czech Republic
  • M. Chartier - Chiltern International, Neuilly, France
  • C. Poncet - Docs International, Sèvres, France
  • C. Rauch - Bristol-Myers Squibb, München
  • Manuela Le Bars - Bristol-Myers Squibb, Rueil-Malmaison, France

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 42. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 24. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Düsseldorf, 17.-20.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocRA.10

doi: 10.3205/14dgrh135, urn:nbn:de:0183-14dgrh1354

Published: September 12, 2014

© 2014 Alten et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Background: EULAR recommends biologic initiation in combination with MTX in RA patients after failure of conventional synthetic (cs)DMARDs and in the presence of poor prognostic factors. Low-dose glucocorticoids should also be considered, but should be tapered as rapidly as is clinically feasible.1 We assessed changes over 2 years in concomitant treatment strategy with csDMARDs and, more specifically, glucocorticoids in RA patients who initiated IV abatacept and had previously failed ≥1 biologic 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. Concomitant treatments are reported at abatacept initiation and up to 24 months for patients who remained on abatacept.

Results: Among 1131 evaluable patients, 1009 failed ≥1 biologic. Abatacept was initiated as monotherapy in 237/1009 (23.5%) patients and in combination with a csDMARD in 772/1009 (76.5%) patients. At baseline, glucocorticoids were used by 734/1009 (72.7%) patients (median dose: 7.5 mg; n=692). Concomitant DMARD and glucocorticoid use was assessed in 407/1009 (40.3%) patients who were on abatacept at 24 months and had available data. Abatacept monotherapy was initiated in 88/407 (21.6%) patients and in combination with csDMARDs in 319/407 (78.4%) patients. There was no change in treatment strategy at 24 months in 348/407 (85.5%) patients. Over 24 months, csDMARDs were initiated in 21/407 (5.2%) patients and were stopped in 38/407 (9.3%) patients. The proportion of patients who received glucocorticoids and the median dose decreased from 301/407 (74.0%; 6.5 mg; n=284) at baseline to 237/407 (58.2%; 5 mg; n=232) at 24 months. Over 24 months, glucocorticoids were initiated in 16/407 (3.9%) patients (median dose: 5 mg) and stopped in 80/407 (19.7%). In patients with dose information available, glucocorticoid dose decreased in 88/216 (40.7%) and increased in 19/216 (8.8%).

Conclusion: The majority of patients who initiated IV abatacept remained on the same treatment strategy (monotherapy or combination) at 24 months. The proportion of patients who received glucocorticoids and the corresponding glucocorticoid dose decrease over 24 months were in line with the 2013 EULAR recommendations that glucocorticoids should be tapered to reduce the risk of side effects [1].

Outline

References

1.
Smolen JS, Landewé R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014 Mar;73(3):492-509. DOI: 10.1136/annrheumdis-2013-204573 External link