FRI0131 Potential factors associated with long-term continuation of etanercept
Authors: M. Kamiya, N. Okada, H. Kikuchi, S. Soen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> With the advent of biologic agents, it has become possible to prevent progression of symptoms and joint destruction in rheumatoid arthritis (RA). However, less than half of patients achieve remission. The patient subgroup that benefits from a specific biologic agent remains unclear. Etanercept has been repeatedly reported to have a high long-term continuation rate, and can also be tapered once the therapeutic goal has been achieved. Identification of a patient subgroup that benefits from long-term use of etanercept would not only benefit the patients but would also reduce healthcare costs. <h3>Objectives</h3> The purpose of this study was to evaluate the characteristics of patients who benefited from long-term use of etanercept and patients who discontinued the drug due to loss of efficacy using our hospital records, and evaluated factors that may predict the difference in efficacy. <h3>Methods</h3> We compared RA patients who continued etanercept treatment for at least 3 years, without interruption for 3 months or longer for reasons other than remission, including patients who switched from other biologics (continuation group), and patients who discontinued treatment within 3 years of treatment initiation due to loss of efficacy (discontinuation group). All patients were treated at our hospital before October 31, 2017. Multiple regression analysis was used to determine factors that may predict long-term etanercept efficacy, using 10 patient background characteristics, including age at initiation of etanercept and DAS28ESR, as explanatory variables. <h3>Results</h3> At the time of evaluation, the 3 year continuation rate of etanercept by the Kaplan-Meier method was 49.7%. Reasons for discontinuation included adverse events (33.3%), loss of efficacy (50%), and patient preference (17.3%). The continuation group comprised 87 cases, including 5 cases where etanercept was discontinued due to remission. Initial dose was 50 mg, and relative dose intensity was 0.78 (95% confidence interval 0.66–0.89). The discontinuation group included 51 cases. Regarding patient characteristics at the time of etanercept initiation, age (continuation group 60.1 vs. discontinuation group 66.7, p=0.019), number of previously used biologics (continuation group 1.24 vs. discontinuation group 1.45, p=0.016), and disease duration (continuation group 110.2 months vs. discontinuation group 74.2 months, p=0.035) were statistically significant with α=0.05, suggesting potential utility in predicting long-term response. In contrast, combination therapy with methotrexate (p=0.259), rheumatoid factor, or anti-cyclic citrullinated peptide antibody positivity (p=0.086), and DAS28ESR (p=0.056) were not statistically significant. <h3>Conclusions</h3> Although this was a retrospective study, the results showed that young RA patients who have previously used few biologics, with long disease duration, may be more likely to benefit long-term from etanercept without loss of efficacy. <h3>Disclosure of Interest</h3> None declared