Shipa, Muhammad RA;
Di Cicco, Maria;
Balogh, Emese;
Nitu, Naila A;
Mainuddin, MD;
Bhadauria, Naveen;
Mukerjee, Dev;
(2022)
Drug-Survival Profiling of Second-Line Biologic Therapy in Rheumatoid Arthritis: Choice of Another TNFi or a Biologic of Different Mode of Action?
Modern Rheumatology
, Article roac086. 10.1093/mr/roac086.
(In press).
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Abstract
OBJECTIVES: Aiming to assess the best choice of second-line therapy between second-line TNF-inhibitor (TNFi) and biologics of different mode of action (BDMA-rituximab/tocilizumab/abatacept) in rheumatoid arthritis (RA) by assessing their drug-survival spanning more that 10years, after discontinuation of the first-line TNFi. METHODS: This retrospective-observational drug-survival study was performed across 2-different hospitals in UK by conventional-statistics and machine-learning approach. RESULTS: From a total of 435-patients, 213 [(48.9%); TNFi-n=122 (57.3%), BDMA-n=91(42.7%)] discontinued their second-line biologic [median-drug-survival: TNFi-27months (95%CI 22-32months) vs BDMA-37months (95%CI 32-52months)]. As second-line, BDMA was likely to reduce the risk of treatment-discontinuation [Hazard-ratio/HR-0.63 (95%CI 0.48-0.83)] compared to TNFi, but only in seropositive-patients [HR-0.52 (95%CI 0.38-0.73)], not in seronegative-RA. Uncovered by the survival-tree and adjusted by propensity-score, drug-survival benefit of BDMA over TNFi was not observed if the seropositive-patients were previously exposed to monoclonal-TNFi (HR-0.77, 95% CI 0.49-1.22) versus soluble TNFi (etanercept or its biosimilar) or if first-line TNFi was terminated within 23.9months of initiation (HR-0.97, 95%CI 0.56-1.68). CONCLUSION: BDMA, as second-line biologic, is more likely to be sustained in seropositive-patients particularly if they were previously not exposed monoclonal TNFi. Drug-survival benefit of BDMA was not observed in seronegative-patients or if the first-line TNFi was stopped within 2 years.
| Type: | Article |
|---|---|
| Title: | Drug-Survival Profiling of Second-Line Biologic Therapy in Rheumatoid Arthritis: Choice of Another TNFi or a Biologic of Different Mode of Action? |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/mr/roac086 |
| Publisher version: | https://doi.org/10.1093/mr/roac086 |
| Language: | English |
| Additional information: | © Japan College of Rheumatology 2022. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
| Keywords: | Abatacept, Rheumatoid arthritis, Rituximab, TNF inhibitor, Tocilizumab |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10153426 |
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