TY - JOUR
T1 - The impact of seropositivity on the effectiveness of biologic anti-rheumatic agents
T2 - results from a collaboration of 16 registries
AU - Courvoisier, Delphine S
AU - Chatzidionysiou, Katarina
AU - Mongin, Denis
AU - Lauper, Kim
AU - Mariette, Xavier
AU - Morel, Jacques
AU - Gottenberg, Jacques-Eric
AU - Bergstra, Sytske Anne
AU - Suarez, Manuel Pombo
AU - Codreanu, Catalin
AU - Kvien, Tore K
AU - Santos, Maria Jose
AU - Pavelka, Karel
AU - Hetland, Merete L
AU - Askling, Johan
AU - Turesson, Carl
AU - Kubo, Satoshi
AU - Tanaka, Yoshiya
AU - Iannone, Florenzo
AU - Choquette, Denis
AU - Nordström, Dan C
AU - Rotar, Ziga
AU - Lukina, Galina
AU - Gabay, Cem
AU - Van Vollenhoven, Ronald
AU - Finckh, Axel
N1 - COPECARE
PY - 2021/2/1
Y1 - 2021/2/1
N2 - OBJECTIVES: RF and ACPA are used as diagnostic tools and their presence has been associated with clinical response to some biologic DMARDs (bDMARDs) in RA. This study compared the impact of seropositivity on drug discontinuation and effectiveness of bDMARDs in patients with RA, using head-to-head comparisons in a real-world setting.METHODS: We conducted a pooled analysis of 16 observational RA registries. Inclusion criteria were a diagnosis of RA, initiation of treatment with rituximab (RTX), abatacept (ABA), tocilizumab (TCZ) or TNF inhibitors (TNFis) and available information on RF and/or ACPA status. Drug discontinuation was analysed using Cox regression, including drug, seropositivity, their interaction, adjusting for concomitant and past treatments and patient and disease characteristics and accounting for country and calendar year of bDMARD initiation. Effectiveness was analysed using the Clinical Disease Activity Index evolution over time.RESULTS: Among the 27 583 eligible patients, the association of seropositivity with drug discontinuation differed across bDMARDs (P for interaction <0.001). The adjusted hazard ratios for seropositive compared with seronegative patients were 1.01 (95% CI 0.95, 1.07) for TNFis, 0.89 (0.78, 1.02)] for TCZ, 0.80 (0.72, 0.88) for ABA and 0.70 (0.59, 0.84) for RTX. Adjusted differences in remission and low disease activity rates between seropositive and seronegative patients followed the same pattern, with no difference in TNFis, a small difference in TCZ, a larger difference in ABA and the largest difference in RTX (Lundex remission difference +5.9%, low disease activity difference +11.6%).CONCLUSION: Seropositivity was associated with increased effectiveness of non-TNFi bDMARDs, especially RTX and ABA, but not TNFis.
AB - OBJECTIVES: RF and ACPA are used as diagnostic tools and their presence has been associated with clinical response to some biologic DMARDs (bDMARDs) in RA. This study compared the impact of seropositivity on drug discontinuation and effectiveness of bDMARDs in patients with RA, using head-to-head comparisons in a real-world setting.METHODS: We conducted a pooled analysis of 16 observational RA registries. Inclusion criteria were a diagnosis of RA, initiation of treatment with rituximab (RTX), abatacept (ABA), tocilizumab (TCZ) or TNF inhibitors (TNFis) and available information on RF and/or ACPA status. Drug discontinuation was analysed using Cox regression, including drug, seropositivity, their interaction, adjusting for concomitant and past treatments and patient and disease characteristics and accounting for country and calendar year of bDMARD initiation. Effectiveness was analysed using the Clinical Disease Activity Index evolution over time.RESULTS: Among the 27 583 eligible patients, the association of seropositivity with drug discontinuation differed across bDMARDs (P for interaction <0.001). The adjusted hazard ratios for seropositive compared with seronegative patients were 1.01 (95% CI 0.95, 1.07) for TNFis, 0.89 (0.78, 1.02)] for TCZ, 0.80 (0.72, 0.88) for ABA and 0.70 (0.59, 0.84) for RTX. Adjusted differences in remission and low disease activity rates between seropositive and seronegative patients followed the same pattern, with no difference in TNFis, a small difference in TCZ, a larger difference in ABA and the largest difference in RTX (Lundex remission difference +5.9%, low disease activity difference +11.6%).CONCLUSION: Seropositivity was associated with increased effectiveness of non-TNFi bDMARDs, especially RTX and ABA, but not TNFis.
KW - ACPA
KW - anti-citrullinated protein antibodies
KW - drug retention
KW - PANABA
KW - rheumatoid arthritis
KW - rheumatoid factor
KW - seropositivity
KW - TOCERRA
UR - http://www.scopus.com/inward/record.url?scp=85102212632&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keaa393
DO - 10.1093/rheumatology/keaa393
M3 - Journal article
C2 - 32810263
SN - 1462-0324
VL - 60
SP - 820
EP - 828
JO - Rheumatology (Oxford, England)
JF - Rheumatology (Oxford, England)
IS - 2
ER -