Article
Do Changes in Clinical Practice over Time in Europe and Canada Have an Impact on Baseline Characteristics of Patients Initiating Intravenous Abatacept in the ACTION Study?
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Authors
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Hubert G. Nüßlein
- Rheumatologische Schwerpunktpraxis, Nürnberg
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Rieke H.-E. Alten
- Schlossparkklinik, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Innere Medizin II, Rheumatologie, klinische Immunologie und Osteologie, Berlin
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M Galeazzi
- University of Siena, Siena, Italy
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Hanns-Martin Lorenz
- Universitätsklinikum Heidelberg, Medizinische Klinik V, Sektion Rheumatologie, Heidelberg
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A. Cantagrel
- Purpan Hospital, Toulouse, France
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M Chartier
- Chiltern International, Neuilly, France
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C Poncet
- Docs International, Nanterre, France
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C Rauch
- Bristol-Myers Squibb, München
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Manuela Le Bars
- Bristol-Myers Squibb, Rueil-Malmaison, France
| Published: | September 1, 2015 |
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Outline
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Introduction: IV abatacept has been available in Europe for use with MTX in adults with moderate-to-severe RA failing ≥1 anti-TNF since 2007 and approved for first-line use in patients failing conventional synthetic (cs)DMARDs since 2010. In Canada, IV abatacept has been available as mono- or combination therapy for DMARD-failing patients since 2006. An observational, single-clinic, US study demonstrated a shift in abatacept prescription trends towards earlier use in the RA treatment paradigm [1]. Here, we investigate how the IV abatacept patient population of the real-world ACTION study has changed over time.
Methods: ACTION is a 2-year, international, non-interventional cohort of patients with RA who initiated IV abatacept: Cohort A, May 2008–December 2010 (biologic naïve or failed prior biologics); B, September 2010–December 2013 (biologic naïve only); and C, December 2011–December 2013 (failed prior biologic). Patient characteristics are reported. Categories were compared using the chi-square test, or Fisher exact test for small patient numbers; quantitative variables were analysed using the Kruskal–Wallis test.
Results: 2359 patients were enrolled (Cohort A, 1137; B, 553; C, 669); 675 (28.6%) were biologic naïve and 1684 (71.4%) had failed prior biologics; 672 and 1671 were included in this analysis, respectively. Patient characteristics are shown in Table 1 [Tab. 1]. Compared with patients who had failed prior biologics in Cohort A, those in C were older, had longer disease duration, were more frequently anti-cyclic citrullinated peptide seropositive (anti-CCP+), more frequently initiated monotherapy, with a trend for more failed biologics, but had lower DAS28 (CRP), HAQ-DI, and fewer csDMARD failures; fewer differences were observed among biologic-naïve patients in Cohort A versus B, although patients in B had lower DAS28 (CRP) and were more frequently anti-CCP+. Co-morbidity rates were similar across cohorts.
Conclusion: In this real-world setting, differences over time between RA cohorts receiving IV abatacept reflect changes in clinical practice. Lower baseline DAS28 (CRP) and HAQ-DI indicate improved access to biologics for patients with less active disease; more anti-CCP+ patients indicates increased treatment of patients with poor prognosis; more patients failing ≥3 biologics despite awareness of the acceptable abatacept safety profile across all treatment lines reflects access to increasing numbers of biologics.
Note: This abstract was first presented at the EULAR Congress, 10–13 June 2015, Rome, Italy (AB0453) and published in the corresponding supplement of Ann Rheum Dis.
