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Comparative effecti...
Comparative effectiveness of abatacept, rituximab, tocilizumab and TNFi biologics in RA : Results from the nationwide Swedish register
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- Frisell, Thomas (author)
- Karolinska Institutet,Karolinska Institute
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- Dehlin, Mats, 1968 (author)
- Gothenburg University,Göteborgs universitet,University of Gothenburg,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine, Department of Rheumatology and Inflammation Research
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- Di Giuseppe, Daniela (author)
- Karolinska Institutet,Karolinska Institute
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- Feltelius, Nils (author)
- Swedish medical products agency
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- Turesson, Carl (author)
- Lund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Internal Medicine - Epidemiology,Lund University Research Groups,Skåne University Hospital
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- Askling, Johan (author)
- Karolinska Institutet,Karolinska Institute
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- Ernestam, S. (author)
- Karolinska Institutet
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- Klareskog, L. (author)
- Karolinska Institutet
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Nisell, R. (author)
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Baecklund, E. (author)
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Kastbom, A. (author)
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Jacobsson, L. (author)
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Lindqvist, E. (author)
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d'Elia, H. F. (author)
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Rantapaa-Dahlqvist, S (author)
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(creator_code:org_t)
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- 2019-01-21
- 2019
- English 11 s.
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In: Rheumatology (United Kingdom). - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 58:8, s. 1367-1377
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Abstract
Subject headings
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- Objectives: Current guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as having equal effectiveness for the treatment of RA, at least as second line therapies. These recommendations are mainly based on meta-analysis of randomized controlled trials, with few direct drug-drug comparisons. Our objective was to compare the real-world absolute and relative effectiveness among RA patients starting any of the available biologic DMARDs (bDMARDs). Methods: We used the Swedish Rheumatology Register to identify patients with RA initiating TNFi, rituximab, abatacept or tocilizumab in 2010-2016 as first bDMARD (n = 9333), or after switch from TNFi as first bDMARD (n = 3941). National Swedish registers provided additional covariates and censoring events. Effectiveness was assessed 3 and 12 months after treatment start, as the proportion remaining on therapy and with EULAR Good Response, HAQ improvement >0.2, zero swollen/tender joints and CDAI remission. Adjusted differences were estimated with multivariable linear regression. Results: Patients starting non-TNFi (vs TNFi) as first bDMARD had a higher proportion remaining on drug and reaching most response outcomes as first bDMARD (1-year EULAR Good Response/HAQ improvement: TNFi 24.9/25.4%, rituximab 28.6/37.2%, abatacept 31.9/33.7%, tocilizumab 50.9/43.1%). After switch from a first TNFi, rituximab and tocilizumab, but not abatacept, were associated with significantly better response measures than TNFi (1-year EULAR Good Response/HAQ improvement: TNFi 11.6/16.1%, rituximab 24.8/33.2%, abatacept 13.1/17.5%, tocilizumab 34.1/29.4%). Differences remained significant after adjusting for potential confounders. Conclusion: Treatment outcomes among RA patients treated in Swedish clinical practice are in line with a superior effectiveness of non-TNFi bDMARDs, in particular tocilizumab and rituximab, compared with TNFi.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Farmakologi och toxikologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Pharmacology and Toxicology (hsv//eng)
Keyword
- abatacept
- anti-TNF
- biologics
- effectiveness
- rheumatoid arthritis
- rituximab
- tocilizumab
- treatment outcome
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Frisell, Thomas
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Dehlin, Mats, 19 ...
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Di Giuseppe, Dan ...
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Feltelius, Nils
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Turesson, Carl
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Askling, Johan
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show more...
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Ernestam, S.
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Klareskog, L.
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Nisell, R.
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Baecklund, E.
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Kastbom, A.
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Jacobsson, L.
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Lindqvist, E.
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d'Elia, H. F.
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Rantapaa-Dahlqvi ...
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show less...
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Rheumatology (Un ...
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Lund University
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University of Gothenburg
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Karolinska Institutet