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Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland.
RMD Open. 2020 05; 6(1)RO

Abstract

BACKGROUND

Multiple biologic and targeted synthetic disease-modifying rheumatic drugs (b/tsDMARDs) are approved for the management of rheumatoid arthritis (RA), including TNF inhibitors (TNFi), bDMARDs with other modes of action (bDMARD-OMA) and Janus kinase inhibitors (JAKi). Combination of b/tsDMARDs with conventional synthetic DMARDs (csDMARDs) is recommended, yet monotherapy is common in practice.

OBJECTIVE

To compare drug maintenance and clinical effectiveness of three alternative treatment options for RA management.

METHODS

This observational cohort study was nested within the Swiss RA Registry. TNFi, bDMARD-OMA (abatacept or anti-IL6 agents) or the JAKi tofacitinib (Tofa) initiated in adult RA patients were included. The primary outcome was overall drug retention. We further analysed secondary effectiveness outcomes and whether concomitant csDMARDs modified effectiveness, adjusting for potential confounding factors.

RESULTS

4023 treatment courses of 2600 patients were included, 1862 on TNFi, 1355 on bDMARD-OMA and 806 on Tofa. TNFi was more frequently used as a first b/tsDMARDs, at a younger age and with shorter disease duration. Overall drug maintenance was significantly lower with TNFi compared with Tofa [HR 1.29 (95% CI 1.14 to 1.47)], but similar between bDMARD-OMA and Tofa [HR 1.09 (95% CI 0.96 to 1.24)]. TNFi maintenance was decreased when prescribed without concomitant csDMARDs [HR: 1.27 (95% CI 1.08 to 1.49)], while no difference was observed for bDMARD-OMA or Tofa maintenance with respect to concomitant csDMARDs.

CONCLUSION

Tofa drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa.

Authors+Show Affiliations

Department of Internal Medicine Specialties, University Hospitals Geneva, Geneva, Switzerland.Statistics Group, SCQM Foundation, Zurich, Switzerland.Statistics Group, SCQM Foundation, Zurich, Switzerland. Zurich University of Applied Sciences, Institute of Data Analysis and Process Design (IDP), Winterthur, Switzerland.Statistics Group, SCQM Foundation, Zurich, Switzerland.Inselspital und Universitätsspital Bern, Bern, Switzerland.University Hospital Zurich, Zurich, Switzerland.Private Practice, Basel, Switzerland.Department of Internal Medicine Specialties, University Hospitals Geneva, Geneva, Switzerland.Department of Rheumatology, University Hospital Basel, Basel, Switzerland.Rheumatology, Réseau hospitalier neuchâtelois, La Chaux-de-Fonds,Switzerland.Kantonsspital Aarau, Aarau, Switzerland.Kantonsspital Aarau, Aarau, Switzerland.Centres Hospitaliers Universitaires Vaudois, Lausanne, Switzerland.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32385143

Citation

Finckh, A, et al. "Comparative Effectiveness of Antitumour Necrosis Factor Agents, Biologics With an Alternative Mode of Action and Tofacitinib in an Observational Cohort of Patients With Rheumatoid Arthritis in Switzerland." RMD Open, vol. 6, no. 1, 2020.
Finckh A, Tellenbach C, Herzog L, et al. Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland. RMD Open. 2020;6(1).
Finckh, A., Tellenbach, C., Herzog, L., Scherer, A., Moeller, B., Ciurea, A., von Muehlenen, I., Gabay, C., Kyburz, D., Brulhart, L., Müller, R., Hasler, P., & Zufferey, P. (2020). Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland. RMD Open, 6(1). https://doi.org/10.1136/rmdopen-2020-001174
Finckh A, et al. Comparative Effectiveness of Antitumour Necrosis Factor Agents, Biologics With an Alternative Mode of Action and Tofacitinib in an Observational Cohort of Patients With Rheumatoid Arthritis in Switzerland. RMD Open. 2020;6(1) PubMed PMID: 32385143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland. AU - Finckh,A, AU - Tellenbach,C, AU - Herzog,L, AU - Scherer,A, AU - Moeller,B, AU - Ciurea,A, AU - von Muehlenen,I, AU - Gabay,C, AU - Kyburz,D, AU - Brulhart,L, AU - Müller,R, AU - Hasler,P, AU - Zufferey,P, AU - ,, PY - 2020/01/08/received PY - 2020/02/11/revised PY - 2020/03/02/accepted PY - 2020/5/10/entrez PY - 2020/5/10/pubmed PY - 2020/5/10/medline KW - abatacept KW - biological therapies KW - comparative effectiveness research KW - rheumatoid arthritis KW - tocilizumab KW - tumour necrosis alpha inhibitors JF - RMD open JO - RMD Open VL - 6 IS - 1 N2 - BACKGROUND: Multiple biologic and targeted synthetic disease-modifying rheumatic drugs (b/tsDMARDs) are approved for the management of rheumatoid arthritis (RA), including TNF inhibitors (TNFi), bDMARDs with other modes of action (bDMARD-OMA) and Janus kinase inhibitors (JAKi). Combination of b/tsDMARDs with conventional synthetic DMARDs (csDMARDs) is recommended, yet monotherapy is common in practice. OBJECTIVE: To compare drug maintenance and clinical effectiveness of three alternative treatment options for RA management. METHODS: This observational cohort study was nested within the Swiss RA Registry. TNFi, bDMARD-OMA (abatacept or anti-IL6 agents) or the JAKi tofacitinib (Tofa) initiated in adult RA patients were included. The primary outcome was overall drug retention. We further analysed secondary effectiveness outcomes and whether concomitant csDMARDs modified effectiveness, adjusting for potential confounding factors. RESULTS: 4023 treatment courses of 2600 patients were included, 1862 on TNFi, 1355 on bDMARD-OMA and 806 on Tofa. TNFi was more frequently used as a first b/tsDMARDs, at a younger age and with shorter disease duration. Overall drug maintenance was significantly lower with TNFi compared with Tofa [HR 1.29 (95% CI 1.14 to 1.47)], but similar between bDMARD-OMA and Tofa [HR 1.09 (95% CI 0.96 to 1.24)]. TNFi maintenance was decreased when prescribed without concomitant csDMARDs [HR: 1.27 (95% CI 1.08 to 1.49)], while no difference was observed for bDMARD-OMA or Tofa maintenance with respect to concomitant csDMARDs. CONCLUSION: Tofa drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa. SN - 2056-5933 UR - https://www.unboundmedicine.com/medline/citation/32385143/Comparative_effectiveness_of_antitumour_necrosis_factor_agents_biologics_with_an_alternative_mode_of_action_and_tofacitinib_in_an_observational_cohort_of_patients_with_rheumatoid_arthritis_in_Switzerland_ L2 - https://rmdopen.bmj.com/cgi/pmidlookup?view=long&pmid=32385143 DB - PRIME DP - Unbound Medicine ER -
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