FRI0082 EFFECTIVENESS OF TNF INHIBITORS VS. NON-TNF INHIBITORS (ABATACEPT, TOCILIZUMAB AND RITUXIMAB) AFTER FAILURE OF NON-TNFI BIOLOGIC DMARD IN RHEUMATOID ARTHRITIS –COLLABORATION BETWEEN FIVE NATIONAL REGISTERS
Authors: Katerina Chatzidionysiou, Merete L. Hetland, Thomas Frisell, Daniela DI Giuseppe, Karin Hellgren, Bente Glintborg, Dan Nordström, Kalle Aaltonen, Nina Trokovic, Eirik Kristianslund, Tore K. Kvien, Sella Aarrestad Provan, Björn Gudbjornsson, Gerdur Gröndal, Lene Dreyer, Lars Erik Kristensen, Tanja Schjødt Jørgensen, Lennart T.H. Jacobsson, Johan Askling
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The optimal sequencing of biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) in Rheumatoid Arthritis (RA) is unknown. Evidence regarding the effectiveness of a 2<sup>nd</sup> non-TNFi bDMARD, as well as of TNFi, in patients whose 1<sup>st</sup> bDMARD has been a non-TNFi is limited. <h3>Objectives:</h3> To characterize patients switching for medical reasons after failure of a non-TNFi used as 1<sup>st</sup> bDMARD, and to assess the effectiveness of rituximab (RTX), abatacept (ABA) or tocilizumab (TCZ) vs. a TNFi. <h3>Methods:</h3> Patients from 5 national registers (Sweden, Norway, Denmark, Iceland and Finland) with RA who started treatment with a non-TNFi as a 1<sup>st</sup> bDMARD after 2010 and switched to a 2<sup>nd</sup> bDMARD within 3 months after the discontinuation of the 1<sup>st</sup> (with the exception of RTX for which a 6-month window was used), were identified. Clinical effectiveness was assessed by DAS28 change at 6 months. <h3>Results:</h3> 611 patients were included in the analyses. 80% were female, the majority were positive for RF (76%) and anti-CCP (69%). The mean (±SD) age, DAS28 and HAQ at baseline was 58 (13), 4.5 (1.4) and 1.3 (0.7), respectively, while the median (IQR) disease duration was 5.0 (2.2-12.0) years. Baseline characteristics of patients and the clinical response for each switching strategy are shown in table 1. Moderate responses were observed for most switching strategies. 63% of patients were still on treatment with their 2<sup>nd</sup> bDMARD at 6 months after switch. <h3>Conclusion:</h3> The six-month drug retention for a 2<sup>nd</sup> bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as 1<sup>st</sup> ever bDMARD was lower than two thirds (63%). More detailed analyses are exploring potential subgroups of patients for whom specific switching strategies are more effective. <h3>Acknowledgement:</h3> The study was partly funded by a study grant from NordForsk and Foreum. <h3>Disclosure of Interests:</h3> Katerina Chatzidionysiou: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis, Thomas Frisell: None declared, Daniela Di Giuseppe: None declared, Karin Hellgren: None declared, Bente Glintborg Grant/research support from: Biogen, Pfizer, AbbVie, Dan Nordström Grant/research support from: MSD, Pfizer, Consultant for: AbbVie, BMS, MSD, Novartis, Roche, Pfizer, UCB, Speakers bureau: Novartis, UCB, Kalle Aaltonen: None declared, Nina Trokovic: None declared, Eirik kristianslund: None declared, Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, Sella Aarrestad Provan Consultant for: Novartis, Speakers bureau: Lilly, Björn Gudbjornsson: None declared, Gerdur Gröndal : None declared, Lene Dreyer Consultant for: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: UCB, MSD, Eli Lilly and Janssen Pharmaceuticals., Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals, Tanja Schjødt Jørgensen Consultant for: Abbvie, Roche, Novartis, UCB, Biogen, Eli Lilly., Speakers bureau: Abbvie, Roche, Novartis, UCB, Biogen, Eli Lilly., Lennart T.H. Jacobsson Consultant for: LJ has received lecture and consulting fees from Pfizer, Abbvie, Novartis, Eli-Lily and Janssen, Johan Askling Grant/research support from: Karolinska Institutet (JA) has or has had research agreements with the following pharmaceutical companies, mainly in the context of the ATRIS national safety monitoring programme for rheumatology biologicals: Abbvie, BMS, MSD, Eli Lilly, Pfizer, Roche, Samsung Bioepis, and UCB., Consultant for: Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Lilly, Novartis, and Pfizer.