Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study.

To compare the effectiveness and safety of three non-tumour necrosis factor (TNF) α inhibitors (rituximab, abatacept, and tocilizumab) in the treatment of rheumatoid arthritis. Population based prospective study. 53 university and 54 non-university clinical centres in France. 3162 adults (>18 years) with rheumatoid arthritis according to 1987 American College of Rheumatology criteria, enrolled in one of the three French Society of Rheumatology registries; who had no severe cardiovascular disease, active or severe infections, or severe immunodeficiency, with follow-up of at least 24 months. Initiation of intravenous rituximab, abatacept, or tocilizumab for rheumatoid arthritis. The primary outcome was drug retention without failure at 24 months. Failure was defined as all cause death; discontinuation of rituximab, abatacept, or tocilizumab; initiation of a new biologic or a combination of conventional disease modifying antirheumatic drugs; or increase in corticosteroid dose >10 mg/d compared with baseline at two successive visits. Because of non-proportional hazards, treatment effects are presented as life expectancy difference without failure (LED Average durations of survival without failure were 19.8 months for rituximab, 15.6 months for abatacept, and 19.1 months for tocilizumab. Average durations were greater with rituximab (LED Among adults with refractory rheumatoid arthritis followed-up in routine practice, rituximab and tocilizumab were associated with greater improvements in outcomes at two years compared with abatacept.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: JEG reports personal fees from AbbVie, MSD, Janssen, Pfizer, UCB, and Lilly; grants and personal fees from Bristol-Meyers Squibb and Roche during the conduct of the study; and grants from Pfizer and Bristol-Meyers Squibb outside the submitted work. BC reports personal fees from Abbvie, Bristol-Meyers Squibb, Lilly, MSD, Janssen, Pfizer, Roche, Chigai, and Sanofi, during the conduct of the study, and grants from Abbvie, Bristol-Meyers Squibb, Lilly, MSD, Janssen, Pfizer, Roche, Chugai, and Sanofi outside the submitted work. MD reports grants and personal fees from Bristol-Meyers Squibb, AbbVie, Pfizer, Novartis, Lilly, UCB, Merck, and Janssen outside the submitted work. R-MF reports grants and personal fees from Roche, Chugai, Abbvie, and Pfizer, and personal fees from Bristol-Meyers Squibb outside the submitted work. AS reports grants, personal fees, and non-financial support from Roche, Chugai, and Bristol-Meyers Squibb outside the submitted work. TS reports and has been implicated in clinical trials for all the disease modifying antirheumatic drugs that are considered in the paper. JS reports personal fees from Roche, Chugai, and Bristol-Meyers Squibb during the conduct of the study, and personal fees from Roche, Chugai, Bristol-Meyers Squibb, UCB, GSK, LFB, Actelion, Pfizer, MSD, Novartis, Amgen, Hospira, AbbVie, Sandoz, Gilead, Lilly, Sanofi, Janssen, and Mylan outside the submitted work. OV reports personal fees from Bristol Myers Squibb, Roche, Chugai, MSD, Novartis, Pfizer, Abbvie, and Lilly outside the submitted work. AC reports personal fees from Bristol-Meyers Squibb, Chugai, Roche, Abbvie, MSD, Pfizer, and UCB outside the submitted work. XM received an honorarium for participation in boards without any relation to this study from Bristol-Meyers Squibb, GSK, Janssen, Pfizer, and UCB.