Nüßlein, Hubert G.
Nurmohamed, Michael T.
Bensen, William G.
Burmester, Gerd R.
Bars, Manuela Le
Background The emergence of new therapies for the treatment of rheumatoid
arthritis (RA), the paucity of head-to-head studies, and the heterogeneous
nature of responses to current biologics highlight the need for the
identification of prognostic factors for treatment response and retention in
clinical practice. Prognostic factors for patient retention have not been
explored thoroughly despite data for abatacept and other biologics being
available from national registries. Real-world data from the ACTION study may
supplement the findings of randomized controlled trials and show how abatacept
is used in clinical practice. The aim of this interim analysis was to identify
prognostic factors for abatacept retention in patients with RA who received at
least one prior biologic agent. Methods A large, international, non-
interventional cohort of patients with moderate-to-severe RA who initiated
intravenous abatacept in Canada and Europe (May 2008–January 2011) enrolled in
the ACTION study. Potential prognostic factors for retention in this interim
analysis (data cut-off February 2012; including patients from Canada, Germany,
Greece, and Italy) were baseline demographics and disease characteristics,
medical history, and previous and concomitant medication. Clinically relevant
variables with p ≤ 0.20 in univariate analysis and no collinearity were
entered into a Cox proportional hazards regression model, adjusted for
clustered data. Variables with p ≤ 0.10 were retained in the final model
(backward selection). Results The multivariate model included 834 patients.
Anti-cyclic citrullinated peptide (CCP) antibody positivity (hazard ratio [95
% confidence interval]: 0.55 [0.40, 0.75], p < 0.001), failure of <2 prior
anti-tumor necrosis factors (TNFs) (0.71 [0.56, 0.90], p = 0.005 versus ≥2
prior anti-TNFs), and cardiovascular comorbidity at abatacept initiation (0.48
[0.28, 0.83], p = 0.009) were associated with lower risk of abatacept
discontinuation. Patients in Greece and Italy were less likely to discontinue
abatacept than patients in Germany and Canada (Greece: 0.30 [0.16, 0.58];
Italy: 0.50 [0.33, 0.76]; Canada: 1.04 [0.78, 1.40], p < 0.001 versus
Germany). Conclusions Real-world prognostic factors for abatacept retention
include anti-CCP positivity and fewer prior anti-TNF failures. Differences in
retention rates between countries may reflect differences in healthcare
systems. The finding that abatacept has potential advantages in patients with
cardiovascular comorbidities needs to be confirmed in further research.
Cyclic citrullinated peptide
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit
Prognostic factors for abatacept retention in patients who received at least
one prior biologic agent
BMC Musculoskeletal Disorders. - 16 (2015), Artikel Nr. 176
an interim analysis from the observational, prospective ACTION study
Charité - Universitätsmedizin Berlin
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