THU0204 Retention Rate of Biologic Agents after Remission Induced with and without Concomitant Glucocorticoid Treatment in Patients with Rheumatoid Arthritis: A Propensity Score Matched Analysis
Authors: S. Asai, T. Kojima, N. Takahashi, K. Funahashi, N. Ishiguro
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Concomitant glucocorticoids effectively increase remission rate in patients with early rheumatoid arthritis (RA) treated with synthetic DMARDs.<sup>1</sup> However, it remains unclear whether concomitant glucocorticoids have additive effects over biologic agents after achieving remission in the patients with RA. Given that drug retention reflects a good balance between effectiveness and tolerability, assessing the retention rate and reasons for discontinuation is important for drug evaluation. <h3>Objectives</h3> To compare retention rate of biologic agents for the patients who achieved clinical remission with and without concomitant glucocorticoid treatment [GC(+) and GC(−) groups, respectively], and investigate the predictors of drug discontinuation due to insufficiency in the GC(+) group. <h3>Methods</h3> A cohort study was performed using a multicentre registry. A total of 404 patients with RA achieved clinical remission defined as a DAS28-CRP &lt;2.6 within the first year of treatment with the first biologic agents. Of all patients, 202 (50%) received concomitant glucocorticoids at achieving remission. Propensity score matching was performed given concerns of treatment-selection bias, and a total of 128 matched pairs of patients were identified. The first year follow-up time point after registration, which almost reflected the time of achieving remission, was considered the baseline in this study. The cumulative retention rate of the first biologic agents was estimated using Kaplan-Meier curves and compared with the log-rank test, and the impact of baseline characteristics on the drug discontinuation due to insufficiency in the GC(+) group was assessed with Cox proportional hazards models. <h3>Results</h3> There was good balance across all baseline characteristics after propensity score matching (Table 1). Six of the 128 patients (4.7%) in the GC(−) group discontinued the first biologic agents due to insufficiency during the follow-up period, while 31 of the 128 patients (24.2%) in the GC(+) group did so. According to Kaplan-Meier estimates, the discontinuation rate due to insufficiency for the GC(+) group was significantly higher than that for the GC(−) group (37% vs. 7%, respectively, at 5 years, <i>P</i>&lt;0.001) (Fig. 1A). The number of patients who discontinued biologic agents due to adverse events (infection) during the follow-up period was 10 (6) and 11 (6) in the GC(−) and (+) group, respectively. According to Kaplan-Meier estimates, there was no significant difference among the GC(−) and (+) group in the discontinuation rate due to adverse events (11% vs. 16%, respectively, at 5 years, <i>P</i>=0.676) (Fig. 1B). Multivariate analysis using Cox proportional hazards models revealed that Steinbrocker stage (III+IV vs. I+II) (HR: 3.37, 95% CI: 1.09–10.44, <i>P</i>=0.035) independently predicted drug discontinuation due to insufficiency in the GC(+) group. <h3>Conclusions</h3> The patients who achieved remission with concomitant glucocorticoid treatment, especially with Joint destruction existing at achieving remission, had a high risk of subsequent discontinuation of biologic agents due to insufficiency. <h3>References</h3> Svensson B, et al. Arthritis Rheum 2005;52:3360–70. <h3>Disclosure of Interest</h3> S. Asai Speakers bureau: Eisai Pharma Corporation, T. Kojima Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, AbbVie, Bristol-Myers Squibb, Pfizer, Janssenn Pharmaceutical Companies, Astellas Pharma, Chugai Pharma Corporation, N. Takahashi Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, AbbVie, Bristol-Myers Squibb, Janssenn Pharmaceutical Companies, UCB Japan Co, Chugai Pharma Corporation, K. Funahashi: None declared, N. Ishiguro Grant/research support from: Daiichi Sankyo, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Taisho Toyama Pharmaceutical,Kaken Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, AbbVie, Bristol-Myers Squibb, Pfizer, Janssenn Pharmaceutical Companies, Astellas Pharma, Chugai Pharma Corporation, Speakers bureau: Daiichi Sankyo, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Taisho Toyama Pharmaceutical,Kaken Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, AbbVie, Bristol-Myers Squibb, Pfizer, Janssenn Pharmaceutical Companies, Astellas Pharma, Chugai Pharma Corporation