The comparative effectiveness of abatacept versus anti-tumour necrosis factor switching for rheumatoid arthritis patients previously treated with an anti-tumour necrosis factor

被引:59
|
作者
Harrold, Leslie R. [1 ]
Reed, George W. [1 ]
Kremer, Joel M. [2 ]
Curtis, Jeffrey R. [3 ]
Solomon, Daniel H. [4 ]
Hochberg, Marc C. [5 ,6 ]
Greenberg, Jeffrey D. [7 ]
机构
[1] Univ Massachusetts, Sch Med, Worcester, MA 01655 USA
[2] Albany Med Coll, Albany, NY 12208 USA
[3] Univ Alabama Birmingham, Dept Immunol & Rheumatol, Birmingham, AL USA
[4] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA
[5] Univ Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA
[6] Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA
[7] NYU, Hosp Joint Dis, Dept Rheumatol, New York, NY USA
基金
美国医疗保健研究与质量局; 新加坡国家研究基金会; 美国国家卫生研究院;
关键词
ACUTE-PHASE REACTANTS; BIOLOGIC AGENTS; INADEQUATE RESPONSE; RANDOMIZED-TRIAL; ACTIVITY SCORE; UNITED-STATES; METHOTREXATE; EFFICACY; VALIDATION; INFLIXIMAB;
D O I
10.1136/annrheumdis-2013-203936
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective We compared the effectiveness of abatacept (ABA) versus a subsequent anti-tumour necrosis factor inhibitor (anti-TNF) in rheumatoid arthritis (RA) patients with prior anti-TNF use. Methods We identified RA patients from a large observational US cohort (2/1/2000-8/7/2011) who had discontinued at least one anti-TNF and initiated either ABA or a subsequent anti-TNF. Using propensity score (PS) matching (n:1 match), effectiveness was measured at 6 and 12 months after initiation based on mean change in Clinical Disease Activity Index (CDAI), modified American College of Rheumatology (mACR) 20, 50 and 70 responses, modified Health Assessment Questionnaire (mHAQ) and CDAI remission in adjusted regression models. Results The PS-matched groups included 431 ABA and 746 anti-TNF users at 6 months and 311 ABA and 493 anti-TNF users at 12 months. In adjusted analyses comparing response following treatment with ABA and anti-TNF, the difference in weighted mean change in CDAI (range 6-8) at 6 months (0.46, 95% CI -0.82 to 1.73) and 12 months was similar (-1.64, 95% CI -3.47 to 0.19). The mACR20 responses were similar at 6 (28-32%, p=0.73) and 12 months (35-37%, p=0.48) as were the mACR50 and mACR70 (12 months: 20-22%, p=0.25 and 10-12%, p=0.49, respectively). Meaningful change in mHAQ was similar at 6 and 12 months (30-33%, p=0.41 and 29-30%, p=0.39, respectively) as was CDAI remission rates (9-10%, p=0.42 and 12-13%, p=0.91, respectively). Conclusions RA patients with prior anti-TNF exposures had similar outcomes if they switched to a new anti-TNF as compared with initiation of ABA.
引用
收藏
页码:430 / 436
页数:7
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