1
|
Courvoisier DS, Chatzidionysiou K, Mongin D, Lauper K, Mariette X, Morel J, Gottenberg JE, Bergstra SA, Suarez MP, Codreanu C, Kvien TK, Santos MJ, Pavelka K, Hetland ML, Askling J, Turesson C, Kubo S, Tanaka Y, Iannone F, Choquette D, Nordström DC, Rotar Z, Lukina G, Gabay C, Van Vollenhoven R, Finckh A. The impact of seropositivity on the effectiveness of biologic anti-rheumatic agents: results from a collaboration of 16 registries. Rheumatology (Oxford) 2021; 60:820-828. [PMID: 32810263 DOI: 10.1093/rheumatology/keaa393] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Denis Mongin
- Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Kim Lauper
- Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.,Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Jacques Morel
- Rheumatology, CHU and University of Montpellier, Montpellier, France
| | | | | | | | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Tore K Kvien
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Karel Pavelka
- Rheumatology, Charles University, Prague, Czech Republic
| | - Merete L Hetland
- DANBIO Registry and Copenhagen Center for Arthritis Research, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Johan Askling
- Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Carl Turesson
- Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Satoshi Kubo
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Florenzo Iannone
- Italian Group for the Study of Early Arthritis, University Hospital of Bari, Bari, Italy
| | - Denis Choquette
- Institut de Recherche en Rhumatologie de Montréal, Centre hospitalier de l'Université de Montréal and Université de Montréal, Montréal, Canada
| | - Dan C Nordström
- ROB-FIN Registry, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Ziga Rotar
- Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Galina Lukina
- Rheumatology, V. A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Cem Gabay
- Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Ronald Van Vollenhoven
- Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Axel Finckh
- Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| |
Collapse
|