Retention rate of a second line with a biologic DMARD after failure of a first-line therapy with abatacept, tocilizumab, or rituximab: results from the Italian GISEA registry.
Abatacept
Retention rate
Rheumatoid arthritis
Rituximab
TNF inhibitors
Tocilizumab
Journal
Clinical rheumatology
ISSN: 1434-9949
Titre abrégé: Clin Rheumatol
Pays: Germany
ID NLM: 8211469
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
02
01
2021
accepted:
07
04
2021
revised:
02
04
2021
pubmed:
22
4
2021
medline:
29
9
2021
entrez:
21
4
2021
Statut:
ppublish
Résumé
EULAR recommendations do not suggest which biologic disease-modifying anti-rheumatic drug (bDMARD) should be preferred after failure of a first bDMARD in the treatment of rheumatoid arthritis (RA). In particular, few data are available regarding the effectiveness of a second-line bDMARD after failure of abatacept (ABA), tocilizumab (TCZ), and rituximab (RTX). The aim of this study was to analyze the retention rate of a second line with tumor necrosis factor inhibitors (TNFi) or other mechanisms of action (MoAs), after the failure of either RTX, TCZ, or ABA. Two hundred and seventy-eight RA patients from the Italian GISEA registry were included in the study. RTX was the first bDMARD in 18% of patients, ABA in 45.7%, and TCZ in 36.3%, while the second bDMARD was a TNFi (group 1) in 129 patients and an agent with a different MoA (group 2) in 149. During a median follow-up of 22 months (IQR 68), 129 patients discontinued their treatment; patients of group 1 discontinued the treatment more frequently than patients of group 2 (p<0.001) with retention rates of 33.6±5.7% and 63.6±4.6% after 104 weeks for group 1 and group 2, respectively (p<0.001). At multivariate analysis, the mechanism of action was the only predictor for the maintenance in therapy. According to our data, ABA, RTX, and TCZ seem to maintain a good retention rate also when used as a second-line therapy, suggesting their use after the failure of a non-TNFi as first-line therapy. However, specifically designed studies are needed to evaluate the more appropriate therapeutic strategies in RA, according to the first-line drug, including new targeted synthetic DMARDs. Key Points • A large proportion of rheumatoid arthritis patients fail the first biologic DMARD. • Few data are available about the efficacy of biologic DMARD after the failure of a non-TNF inhibitor. • Abatacept, rituximab, or tocilizumab seem to maintain a good retention rate after the failure of a first-course therapy with a non-TNF inhibitor.
Identifiants
pubmed: 33881676
doi: 10.1007/s10067-021-05734-3
pii: 10.1007/s10067-021-05734-3
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Antirheumatic Agents
0
Biological Products
0
Rituximab
4F4X42SYQ6
Abatacept
7D0YB67S97
tocilizumab
I031V2H011
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4039-4047Investigateurs
Elena Galli
(E)
Francesco Paolo Cantatore
(FP)
Claudia Lomater
(C)
Fabiola Atzeni
(F)
Roberto Gorla
(R)
Enrico Fusaro
(E)
Fausto Salaffi
(F)
Fabrizio Conti
(F)
Alberto Cauli
(A)
Piercarlo Sarzi-Puttini
(P)
Antonio Carletto
(A)
Giuseppe Lopalco
(G)
Informations de copyright
© 2021. International League of Associations for Rheumatology (ILAR).
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