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Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 1/2020

01-12-2020 | Abatacept | Research article

Abatacept in rheumatoid arthritis: survival on drug, clinical outcomes, and their predictors—data from a large national quality register

Authors: Giovanni Cagnotto, Minna Willim, Jan-Åke Nilsson, Michele Compagno, Lennart T. H. Jacobsson, Saedis Saevarsdottir, Carl Turesson

Published in: Arthritis Research & Therapy | Issue 1/2020

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Abstract

Background

There are limited data regarding efficacy of abatacept treatment for rheumatoid arthritis (RA) outside clinical trials. Quality registers have been useful for observational studies on tumor necrosis factor inhibition in clinical practice. The aim of this study was to investigate clinical efficacy and tolerability of abatacept in RA, using a national register.

Methods

RA patients that started abatacept between 2006 and 2017 and were included in the Swedish Rheumatology Quality register (N = 2716) were investigated. Survival on drug was estimated using Kaplan-Meier analysis. The European League Against Rheumatism (EULAR) good response and Health Assessment Questionnaire (HAQ) response (improvement of ≥ 0.3) rates (LUNDEX corrected for drug survival) at 6 and at 12 months were assessed. Predictors of discontinuation were investigated by Cox regression analyses, and predictors of clinical response by logistic regression. Significance-based backward stepwise selection of variables was used for the final multivariate models.

Results

There was a significant difference in drug survival by previous biologic disease-modifying antirheumatic drug (bDMARD) exposure (p < 0.001), with longer survival in bionaïve patients. Men (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.74–0.98) and methotrexate users (HR 0.85, 95% CI 0.76–0.95) were less likely to discontinue abatacept, whereas a high pain score predicted discontinuation (HR 1.14 per standard deviation, 95% CI 1.07–1.20). The absence of previous bDMARD exposure, male sex, and a low HAQ score were independently associated with LUNDEX-corrected EULAR good response. The absence of previous bDMARD exposure also predicted LUNDEX-corrected HAQ response.

Conclusions

In this population-based study of RA, bDMARD naïve patients and male patients were more likely to remain on abatacept with a major clinical response.
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Metadata
Title
Abatacept in rheumatoid arthritis: survival on drug, clinical outcomes, and their predictors—data from a large national quality register
Authors
Giovanni Cagnotto
Minna Willim
Jan-Åke Nilsson
Michele Compagno
Lennart T. H. Jacobsson
Saedis Saevarsdottir
Carl Turesson
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 1/2020
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/s13075-020-2100-y

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