POS0343 TREATMENT PERSISTENCE AND ADHERENCE AMONG PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS RECEIVING ABATACEPT OR TNF INHIBITORS USING US CLAIMS DATA

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic condition among children and teens1 and contributes to a diminished quality of life.2 Previous data underscore the potential for abatacept to improve health-related outcomes in patients with JIA after demonstrating poor responses to other DMARDs.3 Patients with RA show greater persistence on abatacept vs TNF inhibitors (TNFi), and this should also be confirmed in patients with JIA.4

Objectives

To evaluate treatment persistence and adherence at 12- and 18-month follow-up in patients with JIA newly initiating either abatacept or a TNFi.

Methods

This analysis used data from the IQVIA PharMetrics Plus claims database from Jan 2008–Apr 2021. We identified patients with ≥ 1 claim of JIA diagnosis after Jan 2008, who were < 18 years old at initial diagnosis, had ≥ 1 claim of abatacept or TNFi treatment (adalimumab, etanercept, golimumab) following diagnosis, had continuous enrollment in medical and pharmacy benefits for ≥ 12 months before index date (first prescription of abatacept or TNFi), and had 12 or 18 months’ continuous medical and pharmacy enrollment after index date. Patients receiving abatacept or TNFi treatment ≤ 12 months prior to index date and patients initiating combined abatacept + TNFi treatment on the index date were excluded. Specific outcomes included: discontinuation (absence of a new prescription for index treatment within the gap of 5× treatment half-life), persistence rate (proportion of patients continuing index medication without any gaps exceeding 5× treatment half-life), and treatment adherence (defined as medication possession ratio [MPR, proportion of follow-up period where medication supply is available] and proportion of days covered [PDC, proportion of follow-up period where a patient is covered by a given drug]). All outcomes were reported at 12 and 18 months. All statistical analyses are descriptive with the intent for hypothesis generation.

Results

There were 2847 patients (abatacept, n = 111; TNFi, n = 2736) at 12-month follow-up; fewer completed the 18-month follow-up (2403 patients: abatacept, n = 94; TNFi, n = 2309). At index date, treatment groups were similar for sex, geographic location, and comorbidities (Table 1). Numerically higher persistence was observed in patients prescribed abatacept compared with TNFi overall at both time points. Abatacept persistence was higher than etanercept but similar to adalimumab (Figure 1). At 12 months, the percent of patients with PDC ≥ 0.8 was 57% for abatacept, 51% for adalimumab, and 38% for etanercept, while MPR ≥ 0.8 was 63% for abatacept, 55% for adalimumab, and 42% for etanercept. Patients prescribed abatacept had numerically greater proportions of PDC ≥ 0.8 (abatacept, 48%; adalimumab, 40%; etanercept, 29%) and MPR ≥ 0.8 (abatacept, 53%; adalimumab, 44%; etanercept, 33%) at 18 months.

Table 1.

Baseline characteristics of patients with 12-month follow-up data

CharacteristicAbatacept (n = 111)TNFi (n = 2736)Age, years, mean (SD)14.4 (3.8)12.6 (4.6)Female sex89 (80.2)1930 (70.5)Geographic region South43 (38.7)865 (31.6) Midwest40 (36.0)818 (29.9) West9 (8.1)408 (14.9) East19 (17.1)540 (19.7) Unknown0 (0)105 (3.8)Comorbidities Asthma9 (8.1)275 (10.1) COPD11 (9.9)323 (11.8) Cardiovascular disease14 (12.6)222 (8.1) Uveitis14 (12.6)321 (11.7) Iridocyclitisa12 (10.8)216 (7.9)CCI score, mean (SD)0.58 (0.73)0.46 (0.68)

Data are shown as n (%) unless otherwise specified.

aSubgroup disease under uveitis.

CCI, Charlson Comorbidity Index; COPD, chronic obstructive pulmonary disease.

Conclusion

The present findings suggest that patients with JIA initiating abatacept treatment display numerically higher persistence and adherence compared with patients treated with TNFis at both 12- and 18-months’ follow-up.

References

[1]Prakken B, et al. Lancet 2011;377:2138–49.

[2]Lovell DJ, et al. Arthritis Rheumatol 2015;67:2759–70.

[3]Ruperto N, et al. Lancet 2008;372:383–91.

[4]Han X, et al. J Health Econ Outcomes Res 2021;8:71–8.

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Medical writing and editorial assistance were provided by Ryan Miller, of Caudex, and were funded by Bristol Myers Squibb. Project analysis was provided by Akshay Vinod (Mu Sigma).

Disclosure of Interests

Ching-An Wang Consultant of: Novartis (used to work there as an external contractor from Jan 2016 to Apr 2021), Employee of: Bristol Myers Squibb, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Tzuyung Douglas Kou Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Hanke Zheng Employee of: Bristol Myers Squibb, Keith Wittstock Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vadim Khaychuk Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vardhaman PATEL Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

AB0202 IMPROVEMENT IN CLINICAL DISEASE ACTIVITY AND PATIENT-REPORTED OUTCOMES AFTER 6 MONTHS OF TREATMENT WITH ABATACEPT, STRATIFIED BY LINE OF THERAPY, IN PATIENTS WITH RA: RESULTS FROM A LARGE, US, NATIONAL OBSERVATIONAL STUDY

Background:

RA is more responsive to treatment in the early stages of disease, and early treatment may lead to better long-term outcomes.1,2 Data on the effectiveness of specific drugs as first or later lines of therapy will help inform treatment sequencing.

Objectives:

Data from patients enrolled in the Corrona RA Registry were used to compare the effectiveness of abatacept across lines of therapy overall (primary cohort) and in a subset of patients who were anti-citrullinated protein antibody positive (ACPA+).

Methods:

Patients with RA who initiated abatacept (January 2006 to October 2020), had 6 months’ follow-up (within 4−9 months of starting abatacept), had baseline (BL) and follow-up CDAI scores available, and had BL CDAI >2.8 were included. Outcomes were compared for first-, second- and third or higher-line therapy: 0, 1 or ≥2 prior biologic DMARDs or Janus kinase inhibitors, respectively. Continuous outcomes included change from BL to 6 months in mean CDAI and patient-reported pain, fatigue, and HAQ. Binary outcomes included rate of achieving minimal clinically important difference (MCID) in CDAI or modified ACR20/50/70 at 6 months. Continuous and binary outcomes were analysed using multiple linear and logistic regression, respectively. The models included line of therapy, age, sex, disease duration, work status, SC nodules, history of hypertension and depression, BL CDAI, BL patient-reported pain and BL fatigue. Additional subgroup analyses were carried out in patients with moderate/high disease activity (CDAI >10) at BL.

Results:

In total, 2876 patients (2327 with BL CDAI >10; 890 ACPA+) were included; 442, 911, and 1523 patients initiated first-, second- or third/higher-line abatacept, respectively. Compared with patients on second/third/higher-line abatacept therapy, those on first-line abatacept were significantly older, had shorter disease duration, and had lower BL CDAI, pain and fatigue (all p<0.001). In adjusted analyses, patients receiving abatacept as earlier lines of therapy had significantly greater improvement from BL in mean CDAI and in patient-reported fatigue and HAQ (Table 1). There was no significant difference between lines of therapy in change in patient-reported pain. Patients receiving first-line abatacept had significantly higher odds of achieving a MCID in CDAI or modified ACR20/50/70 response (Figure 1). Similar patterns were seen when the sample was limited to patients with moderate/high disease activity or in patients who were ACPA+.

Conclusion:

There were significant differences in improvement in clinical disease activity and patient-reported outcomes across lines of therapy. Better treatment responses were observed with earlier lines of abatacept therapy in the overall population, in patients who were ACPA+ and in those with moderate/high BL disease activity.

References:

[1]Harrold LR, et al. Clin Rheumatol 2017;36:1215−1220.

[2]Monti S, et al. RMD Open 2015;1(Suppl 1):e000057.

Table 1.

Adjusted mean change in CDAI and patient-reported outcomes from BL to 6 months after initiation of abatacept by line of therapy (primary cohort)

Adjusted outcome, mean change (SE)First-line (n=440)Second-line (n=898)Third/higher-line (n=1515)p valueaCDAI−7.96 (0.33)−7.49 (0.27)−5.74 (0.19)<0.001Patient-reported pain (VAS 0–100)−9.43 (0.69)−7.98 (0.47)−7.70 (0.35)0.074Patient-reported fatigue (VAS 0–100)−7.49 (0.71)−5.87 (0.51)−4.81 (0.36)0.002Patient-reported HAQ−0.16 (0.01)−0.12 (0.01)−0.08 (0.01)<0.001

aEstimated by multiple linear regression model adjusted for age, sex, disease duration, work status, SC nodules, history of hypertension and depression, BL CDAI, BL patient-reported pain and BL fatigue (factors that were identified a priori based on clinical experience or that differed significantly by line of therapy); p values reflect ANOVA overall test of differences across lines of therapy.

VAS=visual analogue scale.

Acknowledgements:

Professional medical writing and editorial assistance was provided by Claire Line, PhD, at Caudex and was funded by Bristol Myers Squibb. The poster was a collaborative effort between Corrona and Bristol Myers Squibb, with financial support provided by Bristol Myers Squibb. This study was sponsored by Corrona, LLC. Corrona is supported through contracted subscriptions with multiple pharmaceutical companies.

Disclosure of Interests:

Leslie Harrold Consultant of: AbbVie, Bristol Myers Squibb, Genentech/Roche, Grant/research support from: Pfizer, Keith Wittstock Employee of: Bristol Myers Squibb, Sheila Kelly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sang Hee Park Employee of: Bristol Myers Squibb, Xue Han Employee of: Bristol Myers Squibb, Ying Shan: None declared, Carla Roberts-Toler: None declared, Nicole Middaugh: None declared, Vadim Khaychuk Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

POS0344 RISK OF ACPA POSITIVITY BY MOTIF-BASED CLASSIFICATION OF HLA-DRB1 SHARED EPITOPE ALLELES IN RA

Background:

The shared epitope (SE) is the strongest known genetic risk factor for rheumatoid arthritis (RA) and is associated with an amino acid motif at positions 70-74 in HLA-DRB1. It is linked to anti-citrullinated protein antibody (ACPA) positivity, a specific serological marker for RA. In 2005, a new classification of HLA-DRB1 alleles was proposed, in which each allele is sorted into one of five classes (S1, S2, S3P, S3D, or X).1 The method was subsequently validated for predicting risk of developing RA2 and was described as “a major advance and a template for future studies.”3 However, there have been relatively few studies utilizing this classification.

Objectives:

To characterize the prevalence of each SE genotype from the 2005 classification and their association with ACPA positivity in a cohort of individuals with RA.

Methods:

Participants in FORWARD, The National Databank for Rheumatic Diseases, with RA and donated serum (collected 2010-2019) were analyzed to obtain ACPA status and high-resolution HLA-DRB1 type. Alleles were classified based on the presence (S2, S3P) or absence (S1, S3D, X; collectively L) of the SE motif, and individuals were classified by allele pair. Logistic regression models (adjusted for age, sex, and race/ethnicity) to determine risk of ACPA positivity by class were generated using L/L as the reference.

Results:

Characteristics of the 855 participants at the time of sample collection are presented in Table 1. Overall, 67% of participants were SE positive and 51% were ACPA positive. Of the 1,710 total alleles, X was the most common (29%) followed by S3P (24%), S1 (18%), S2 (18%), and S3D (9%). Adjusted models showed that the risk of ACPA positivity was highest among those with the genotype S2/S3P, followed by S2/S2, S2/S3D, S2/X, S3P/S3D, S1/S2, S3P/S3P, S3P/X, and S1/S3P (Figure 1).

Table 1.

Characteristics of study population by SE status and allele count (mean [SD] or n [%]). Significance was assessed by Student’s t-test or Χ2 test, as appropriate.

SE negativeSE positiveP (SE- vs SE+)0 allelesAll1 allele2 allelesn=286n=569n=407n=162Age, years57.4 (12.3)58.1 (11.8)58.0 (11.9)58.5 (11.5)0.42RA duration, years15.2 (12.8)17.0 (13.9)16.8 (14.1)17.6 (13.4)0.07Female259 (90.6)500 (87.9)359 (88.2)141 (87.0)0.24White260 (90.9)525 (92.3)372 (91.4)153 (94.4)0.49History of smoking117 (40.9)223 (39.2)166 (40.8)57 (35.2)0.63RDCI, 0-92.4 (1.8)2.0 (1.7)2.1 (1.7)1.9 (1.7)<0.01ACPA positive74 (25.9)365 (64.1)241 (59.2)124 (76.5)<0.001RF positive84 (29.4)333 (58.5)219 (53.8)114 (70.4)<0.001Pain VAS, 0-104.2 (2.7)3.6 (2.7)3.7 (2.6)3.5 (2.9)<0.01Patient global severity, 0-104.0 (2.5)3.3 (2.5)3.4 (2.4)3.1 (2.6)<0.001HAQ-II, 0-31.0 (0.7)0.8 (0.6)0.8 (0.6)0.8 (0.6)<0.001csDMARD use204 (71.3)433 (76.1)302 (74.2)131 (80.9)0.13bDMARD use165 (57.7)351 (61.7)244 (59.95)107 (66.0)0.26Corticosteroid use98 (34.3)165 (29.0)121 (29.7)44 (27.2)0.12Figure 1.

Risk of ACPA positivity by the motif-based classification and prevalence of SE by binary status, allele count, and class. The area within each circle is proportionate to the sample size of that group.

Conclusion:

The ranking by risk of ACPA positivity among this RA cohort is similar to the order of risk for developing RA, as determined in the 2006 validation paper for this classification method. A notable trend among the classes with one SE positive allele is the consistent ranking of S3D as higher risk, X in the middle, and S1 as the lowest, suggesting a potential protective effect from S1 alleles. Future work should examine clinical associations with these allele classes, including disease progression and treatment effects.

References:

[1]du Montcel, ST et al. New classification of HLA-DRB1 alleles supports the shared epitope hypothesis of rheumatoid arthritis susceptibility. Arthritis Rheum52, 1063–1068 (2005).

[2]Michou, L et al. Validation of the reshaped shared epitope HLA-DRB1 classification in rheumatoid arthritis. Arthritis Res Ther8, R79 (2006).

[3]Winchester, R. Reshaping Cinderella’s slipper: the shared epitope hypothesis. Arthritis Res Ther8, 109 (2006).

Acknowledgements:

This study was sponsored by Bristol Myers Squibb.

Disclosure of Interests:

Kristin Wipfler: None declared, Xue Han Employee of: Bristol Myers Squibb, Sarah (Sang Hee) Park Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Keith Wittstock Employee of: Bristol Myers Squibb, Kaleb Michaud: None declared

Ivacaftor Reduces Inflammatory Mediators in Upper Airway Lining Fluid From Cystic Fibrosis Patients With a G551D Mutation: Serial Non-Invasive Home-Based Collection of Upper Airway Lining Fluid

In cystic fibrosis (CF) therapy, the recent approval of CF-transmembrane conductance regulator (CFTR) channel modulators is considered to be the major breakthrough. However, the current first-line approach based mainly on pulmonary function to measure effects of the novel therapy, tested by forced expiratory volumes in one second (FEV₁), provides restricted sensitivity to detect early structural damages. Accordingly, there is a need for new sensitive surrogate parameters. Most interestingly, these should quantify inflammation that precedes a decline of pulmonary function. We present a novel method assessing inflammatory markers in the upper airways’ epithelial lining fluid (ELF) obtained by nasal lavage (NL). In contrast to broncho-alveolar lavage, ELF sampling by NL is an attractive method due to its limited invasiveness which allows repeated analyses, even performed in a home-based setting. In a longitudinal cohort study (ClinicalTrials.gov, Identifier: NCT02311140), we assessed changes of inflammatory mediators in 259 serially obtained nasal lavages taken up to every second day before and during therapy with ivacaftor from ten CF patients carrying a G551D mutation. Patients were trained to sample NL-fluid at home, to immediately freeze and transfer chilled secretions to centers. Neutrophil Elastase, Interleukins IL-1β, IL-6 and IL-8 in NL were quantified. During 8-12 weeks of ivacaftor-treatment, median values of IL-1β and IL-6 significantly declined 2.29-fold (2.97→1.30 pg/mL), and 1.13-fold (6.48→5.72 pg/mL), respectively. In parallel, sweat tests and pulmonary function improved considerably. This is the first study assessing changes of airway inflammation on a day-to-day basis in CF patients receiving a newly administered CFTR-modulator therapy. It proves a decline of airway inflammation during ivacaftor-therapy.

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