Biological DMARD retention rates in rheumatoid arthritis: a 10 year study.

Vandana Bhushan, Raif Hijjawi, Jennifer G. Walker, Eliza Pontifex, Fin Cai, E. Michael Shanahan, Liz Briggs, Jem Ninan, Fiona Goldblatt, Mihir D. Wechalekar

Research output: Contribution to journalMeeting Abstractpeer-review

Abstract

Aims: To evaluate biologic (b) DMARD retention rates, explore reasons for switching and compare results to previously published data and existing recommendations for switching in rheumatoid arthritis (RA).

Methods: 185 patients from a dedicated ‘biologics’ clinic commenced a bDMARD between 2008–2018. Retrospective data regarding drug retention and reasons for switching were compared to previous analysis from this centre pre-2008. Additionally, within this 10-year period, data from the first five years was compared to the latter five.

Results: Retention rates were 50%, 45% and 67% for the first, second and third bDMARD respectively. Etanercept (n = 81, 44%) was the most commonly prescribed first bDMARD, followed by adalimumab (n = 40, 22%) and tocilizumab (n = 25, 14%). 47% (n = 92) switched to a second bDMARD due to secondary (n = 40, 43%) or primary failure (n = 18, 20%), or adverse events (n = 13, 14%). The second most commonly used bDMARDs were tocilizumab (n = 25, 27%), and adalimumab (n = 17, 18%).

Data from the last (vs. first) five years revealed improved retention rates of the first (54% vs. 43%) and second (71% vs. 35%) bDMARDs respectively, with tocilizumab (n = 25, 25%) and etanercept (n = 21, 21%) being the most commonly used in the latter vs. etanercept (n = 25, 46%) and adalimumab (n = 14, 26%) in the first five years. Common reasons for switching in the latter five years were secondary failure and adverse events, with primary failure being less common. Comparison with pre-2008 data revealed earlier switching and lower secondary failure rates for the first bDMARD.

Conclusion: Real-life retention rates of the first bDMARD have decreased over time, with earlier switching, likely reflecting lower acceptance of suboptimal response to and greater availability of bDMARDs with differing mechanisms of actions. The greater retention and lower primary failure rates of the second bDMARD in recent years support a strategy of differential bDMARD use informed by patient presentation.
Original languageEnglish
Pages (from-to)49-50
Number of pages2
JournalInternal Medicine Journal
Volume50
Issue numberSupplement 2
DOIs
Publication statusPublished - Jul 2020
EventAustralian Rheumatology Association 60th Annual Scientific Meeting -
Duration: 16 May 202019 May 2020

Keywords

  • DMARD
  • rheumatoid arthritis (RA)
  • drug retention

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