RA Patients With ACPA or RF Positivity Less Likely to Discontinue Abatacept

Xue Han, PhD

Rheumatoid arthritis patients with anti-cyclic citrullinated peptide antibodies or rheumatoid factor positivity are less likely to discontinue abatacept compared with tumor necrosis factor-inhibitors.

The findings of the multi-center retrospective medical record review were presented at the European E-Congress of Rheumatology 2020 (EULAR 2020).

Xue Han, PhD, of Bristol Myers-Squibb, and colleagues from the Partnership for Health Analytic Research in Beverly Hills, California, assessed 12-month treatment persistence in early-line abatacept versus tumor necrosis factor-inhibitor treated patients with rheumatoid arthritis complicated by poor prognostic factors. Han and the team noted the findings were important to understand treatment persistence and switch patterns in rheumatoid arthritis patients with poor prognositc factors in a real-world setting.

The investigators reviewed the medical records of adult patients with poor prognostic factors who were treated at 6 US clinics. Patients were either treated with abatacept or tumor necrosis factor-inhibitors as the first biologic treatment. Tumor necrosis factor-inhibitors were adalimumab, etanercept, infliximab and their biosimilars, certolizumab pegol, or golimumab. The team considered positive anti-cyclic citrullinated peptide antibodies, positive rheumatoid factor antibodies, increased C-reactive protein levels, elevated erythrocyte sedimentation rate levels, and presence of joint erosions as poor prognostic factors.

Han and the team collected data from the first biologic treatment for >1 year. Data were abstracted from the electronic health record, including demographic, disease, and treatment information. Treatment persistence at 12 months and time to discontinuation were reported. They excluded patients with Crohn’s disease, ankylosing spondylitis, ulcerative colitis, psoriatic arthritis, or anal fistula.

Overall, the team collected data on 265 patients, 100 treated with abatacept, and 165 treated with tumor necrosis factor-inhibitors. Of the patients, 163 had positive anti-cyclic citrullinated peptide antibodies and/or rheumatoid factor positivity (55 abatacept, 108 tumor necrosis factor-inhibitors).

Patients who received abatacept were older than the tumor necrosis factor-inhibitor patients (67 vs 60.3 years old; P <.001). There were no statistically significant differences in gender, comorbidities, or duration of treatment.

At 12 months, 83% of patients were persistent compared to 66.1% of the tumor necrosis factor-inhibitor patients (P=.003). The persistence was similar among those with anti-cyclic citrullinated peptide antibodies and/or rheumatoid factor positive patients (83.6% vs 64.8%; P=.012).

The team found patients who took abatacept had a longer time to discontinuation (1423 days for abatacept vs 690 days for tumor necrosis factor-inhibitors; P=.014). The median discontinuation time was 961 days vs 581 days among anti-cyclic citrullinated peptic antibodies and/or rheumatoid factor positive patients (P=.048).

In an adjusted analysis, the risk of all-cause discontinuation was statistically significantly higher among tumor necrosis factor-inhibitors than abatacept patients (1.7; 95% CI, 1.1-2.6; P=.012). The odds were more than 51% lowers that tumor necrosis factor-inhibitor patients were persistent at 12 months compared to abatacept patients. The finding was not statistically significant (P=.071). More patients on tumor necrosis factor-inhibitors discontinued initial treatment due to disease progression (27.3% vs 12%; P=.003).

The differences found may be due to the lower proportion of patients who discontinued abatacept due to disease progression, Han and the team concluded.

The study, “Persistence With Abatacept Versus Tumor Necrosis Factor-Inhibitors For Rheumatoid Arthritis Complicated By Positive Anti-Cyclic Citrullinated Peptide/Rheumatoid Factor Or Other Poor Prognostic Factors,” was published on the EULAR 2020 website.