SAT0157 REAL-WORLD EVALUATION OF PERSISTENCE WITH EARLY-LINE ABATACEPT VERSUS TUMOR NECROSIS FACTOR-INHIBITORS FOR RHEUMATOID ARTHRITIS COMPLICATED BY POOR PROGNOSTIC FACTORS
Authors: Damemarie Paul, Irina Yermilov, Sarah Gibbs, Michael Broder
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Abatacept reduces signs and symptoms, inhibits the progression of structural damage, and improves physical function in adult patients with moderately to severely active rheumatoid arthritis (RA). Real-world data on its use as an early-line biologic agent are limited. <h3>Objectives</h3> To assess 12-month treatment persistence in early-line abatacept versus tumor necrosis factor inhibitor (TNFi) treated patients with RA complicated by poor prognostic factors. <h3>Methods</h3> We performed a multicenter retrospective medical record review of adult RA patients with poor prognostic factors treated at 5 United States clinics located in the West, Midwest, and Southeast. Patients were treated with abatacept or TNFi as the first biologic treatment at the clinic (defined as early line). Poor prognostic factors included positive anti-cyclic citrullinated peptide antibodies, positive rheumatoid factor antibodies, increased C-reactive protein levels, elevated erythrocyte sedimentation rate levels, or presence of joint erosions. TNFis included adalimumab, etanercept, infliximab (and their biosimilars), certolizumab pegol, or golimumab. Data were collected from biologic treatment initiation (between 8/9/11 and 11/14/16) for ≥1 year. Patients with Crohn's disease, ankylosing spondylitis, ulcerative colitis, psoriatic arthritis, or anal fistula were excluded. Demographic, disease, and treatment information (start, stop, reason for discontinuation) was abstracted. Treatment persistence (continuation of index treatment with gap ≤60 days) at 12 months and time to discontinuation were reported. Multivariate logistic and Cox regressions were used to compare 12-month persistence and overall discontinuation rate between abatacept and TNFi, controlling for demographic and clinical characteristics (age, sex, Charlson comorbidity index, RA duration), baseline utilization, and clinic. <h3>Results</h3> Data on 209 patients (88 abatacept, 121 TNFi) were collected. Abatacept patients were older than TNFi patients (64.36 vs. 57.23 years, p&lt;0.001). There were no significant differences in either gender (79.55% vs. 72.73% female, p=0.257) or duration of treatment at the clinic (5.79 vs. 5.10 years, p=0.226) in the abatacept and TNFi cohorts. Median time to discontinuation was 1,672 days for abatacept vs. 612 days for TNFi (p=0.002). At 12 months, 86.36% of abatacept patients were persistent vs. 65.29% of TNFi patients (p&lt;0.001). In the Cox model, rate of discontinuation was 77% higher in TNFi patients (Hazard Ratio 1.767, 95% Confidence Interval (CI) 1.113-2.806, p=0.0158). In the logistic regression, the odds of TNFi patients being persistent at 12 months was 52% lower than abatacept patients, although this difference was not statistically significant (Odds Ratio 0.485, 95% CI 0.208-1.133, p=0.0947). Reasons for discontinuation of index treatment differed between cohorts, including discontinuation due to disease progression (27.78% vs. 53.85%), insurance coverage (19.44% vs. 12.82%), and adverse events of medication (2.78% vs. 11.54%) in abatacept and TNFi patients, respectively (p&lt;0.001). <h3>Conclusion</h3> In a real-world setting, RA patients with poor prognostic factors are significantly less likely to discontinue abatacept compared with TNFi. This difference may be explained by the lower proportion of patients discontinuing abatacept due to disease progression or adverse events related to medication. <h3>Disclosure of Interests</h3> Damemarie Paul Shareholder of: Bristol-Myers Squibb, Employee of: Damemarie Paul is an employee of Bristol-Myers Squibb., Irina Yermilov Employee of: I am an employee of the Partnership for Health Analytic Research (PHAR) LLC, which was paid by BMS to conduct the research described in this abstract, Sarah Gibbs Employee of: I am an employee of the Partnership for Health Analytic Research (PHAR) LLC, which was paid by BMS to conduct the research described in this abstract., Michael Broder Employee of: I am an employee of the Partnership for Health Analytic Research (PHAR) LLC, which was paid by BMS to conduct the research described in this abstract.