Abstract
Aims: To determine real-life biologic (b) DMARD retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.
Methods: Time-to-event analysis for switching of bDMARDs was performed for 253 patients (n= 144 RA, 64 PsA, 45 AS) who commenced their first bDMARD between 2003–2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of bDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. A subset of the data, from mid-2008 onwards, was compared to an historical analysis (2002-2008)1.
Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third bDMARDs across all patients (p = 0.51, logrank test). The respective restricted mean (95%CI) treatment durations, estimated at 8 years of follow-up, were of 59 (54, 64), 53 (44, 62), and 61 (48, 74) months. Switching was more likely in patients with RA and in females; age, disease duration at biologic start, concomitant conventional DMARDs, and seropositivity (for RA) were not associated with risk of switching. The most common reasons for switching in the first and subsequent years were primary (10%) and secondary (25%) failure respectively. Comparison with historical data1 indicated no substantive differences in switching of the first biologic for RA and PsA.
Conclusion: Similar retention rates of the second and third compared to the first bDMARD support a strategy of differential bDMARD use informed by patient presentation. Despite greater availability of bDMARDs with differing mechanisms of action, retention rates of the first bDMARD remain similar to previous years.
Methods: Time-to-event analysis for switching of bDMARDs was performed for 253 patients (n= 144 RA, 64 PsA, 45 AS) who commenced their first bDMARD between 2003–2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of bDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. A subset of the data, from mid-2008 onwards, was compared to an historical analysis (2002-2008)1.
Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third bDMARDs across all patients (p = 0.51, logrank test). The respective restricted mean (95%CI) treatment durations, estimated at 8 years of follow-up, were of 59 (54, 64), 53 (44, 62), and 61 (48, 74) months. Switching was more likely in patients with RA and in females; age, disease duration at biologic start, concomitant conventional DMARDs, and seropositivity (for RA) were not associated with risk of switching. The most common reasons for switching in the first and subsequent years were primary (10%) and secondary (25%) failure respectively. Comparison with historical data1 indicated no substantive differences in switching of the first biologic for RA and PsA.
Conclusion: Similar retention rates of the second and third compared to the first bDMARD support a strategy of differential bDMARD use informed by patient presentation. Despite greater availability of bDMARDs with differing mechanisms of action, retention rates of the first bDMARD remain similar to previous years.
| Original language | English |
|---|---|
| Article number | P91 |
| Pages (from-to) | 41 |
| Number of pages | 1 |
| Journal | Internal Medicine Journal |
| Volume | 51 |
| Issue number | S2 |
| DOIs | |
| Publication status | Published - May 2021 |
| Event | Australian Rheumatology Association 6st Annual Scientific Meeting - Virtual, Australia Duration: 21 May 2021 → 23 May 2021 |
Keywords
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- bMARDS