Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Abatacept in rheumatoid arthritis : Survival on drug, clinical outcomes, and their predictors - Data from a large national quality register

Cagnotto, Giovanni LU orcid ; Willim, Minna LU ; Nilsson, Jan Åke ; Compagno, Michele LU ; Jacobsson, Lennart T.H. ; Saevarsdottir, Saedis and Turesson, Carl LU (2020) In Arthritis Research and Therapy 22(1).
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... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Abatacept, Response predictors, Rheumatoid arthritis, Survival on drug, Treatment outcome
in
Arthritis Research and Therapy
volume
22
issue
1
article number
15
publisher
BioMed Central (BMC)
external identifiers
  • pmid:31969172
  • scopus:85078278426
ISSN
1478-6354
DOI
10.1186/s13075-020-2100-y
language
English
LU publication?
yes
id
31d3db22-4e79-4108-a67f-f2c93bde15d2
date added to LUP
2020-02-07 12:57:14
date last changed
2024-05-15 05:44:29
@article{31d3db22-4e79-4108-a67f-f2c93bde15d2,
  abstract     = {{<p>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 &lt; 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.</p>}},
  author       = {{Cagnotto, Giovanni and Willim, Minna and Nilsson, Jan Åke and Compagno, Michele and Jacobsson, Lennart T.H. and Saevarsdottir, Saedis and Turesson, Carl}},
  issn         = {{1478-6354}},
  keywords     = {{Abatacept; Response predictors; Rheumatoid arthritis; Survival on drug; Treatment outcome}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Arthritis Research and Therapy}},
  title        = {{Abatacept in rheumatoid arthritis : Survival on drug, clinical outcomes, and their predictors - Data from a large national quality register}},
  url          = {{http://dx.doi.org/10.1186/s13075-020-2100-y}},
  doi          = {{10.1186/s13075-020-2100-y}},
  volume       = {{22}},
  year         = {{2020}},
}