AB0415 SURVIVAL OF BIOLOGIC AGENTS WITHIN A COHORT OF GREEK PATIENTS WITH RHEUMATOID ARTHRITIS. REAL WORLD DATA
Authors: Olga Katsouli, Georgia Liantinioti, Panagiota Katsouli, Mary Pappa, Markos Patsouras, Theodoros Angelopoulos, Sotiris Roussos, VLACHOYIANNOPOULOS PANAYIOTIS
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is treated successfully with biologic disease-modifying anti-rheumatic drugs (bDMARDs). However, a significant withdrawal rate, due to non-responsiveness or toxicity, remains a major barrier for their long-term use. <h3>Objectives:</h3> To determine the withdrawal rate of the first bDMARD in a large cohort of RA patients due either, to non-responsiveness or toxicity. <h3>Methods:</h3> In this study, were included retrospectively 220 patients from our outpatient clinic. The following bDMARDs were evaluated: Etanercept (n=66 patients), Adalimumab (n=61 patients), Infliximab (n=70 patients), Rituximab (n=6 patients) and others, such as Certolizumab pegol, Golimumab, Tocilizumab, Anakinra and Abatacept (n=17 patients). Disease activity was regularly measured by DAS-28 until the end of follow up. Kaplan-Meier plots were performed to examine the withdrawal rate of each biologic agent. Severity of AEs was classified according to the Common Terminology Criteria for Adverse Events (CTCAE, version 4.03). <h3>Results:</h3> A total of 220 patients (49 men, 171 women) were included in the analysis. The most frequently used first-line bDMARDs were Infliximab (31.8%), Etanercept (30%) and Adalimumab (27.7%). The median of treatment duration with the first bDMARD was 15 months (Q1:8, Q3:40.5). Taking all bDMARDs as a whole, 126 patients (57,27%) discontinued the first bDMARD, either due to AEs(n=66, 52.38%), or loss of efficacy (n=60,47.62%) after a follow-up of 167 months. However the most withdrawals (53.18%) occurred within the first 60 months of follow-up. Mean initial and final DAS-28 were: for those who discontinued treatment due to AEs 4.96±1.33(95%CI 4.64-5.28) and 3.43±1.47(95%CI, 3.08-3.79), respectively, for those who discontinued due to failure of therapy: 5.04±1.37(95%CI, 4.70-5.39) and 4.91±1.27(95%CI, 4.59-5.23) respectively and for those who continue 4.79±1.55(95%CI, 4.47-5.10) and 2.63±1.06(95%CI, 2.41-2.84), respectively. Differences in survival among bDMARDs are attributed to their AEs and not to their efficacy. As far as the AEs are concerned, infections constituted the majority of cases (n=23, 34.8%), from which 34.8% needed hospitalization (CTCAE 3-4). The percentage of 12,1% of AEs is attributed to cancer cases, while allergic reactions counted for 31,8% of them. Survival of Etanercept within our cohort was significantly longer than those of other bDMARDs. <h3>Conclusion:</h3> Biologic agents are important drugs in our armamentarium to combat RA. However nearly 50% of patients discontinue these agents after 60 months of treatment due either to AEs or inefficacy. Differences in survival of bDMARDs were associated not to their inefficacy, but to their AEs. Choosing the right drug for the right patient is a matter of advanced research involving a better understanding of the plasticity of the pathways of inflammation and specific biomarker selection. <h3>References</h3> [1] C. Lampropoulos, P. Orfanos, M. Manoussakis, A. Tzioufas, H. Moutsopoulos, P. Vlachoyiannopoulos. Treat-to-target biologic therapy in patients with rheumatoid arthritis is more efficacious and safe compared to delayed initiation of biologics:A real-world study.ClinExpRheumatology.2017;35:192-200. [2] C. Lampropoulos, P. Orfanos, V. Bournia, T. Karatsourakis, C. Mavragani, D. Pikazis, M. Manoussakis, A. Tzioufas, H. Moutsopoulos, P. Vlachoyiannopoulos.Adverse events and infections in patients with rheumatoid arthritis treated with conventional drugs or biologic agents: a real world study.ClinExpRheumatology.2015;33:216-224. <h3>Disclosure of Interests:</h3> Olga Katsouli: None declared, Georgia Liantinioti: None declared, Panagiota Katsouli: None declared, MARY PAPPA Employee of: Bayer, Markos Patsouras: None declared, Theodoros Angelopoulos: None declared, Sotiris Roussos: None declared, PANAYIOTIS VLACHOYIANNOPOULOS: None declared