Rheumatoid Arthritis Effectiveness Differs Among Non-TNF Inhibitors

By Will Boggs MD

February 05, 2019

NEW YORK (Reuters Health) - Rheumatoid arthritis outcomes are better with some non-TNF inhibitors than with others, according to French registry data.

"Previously, indirect comparisons (meta-analyses) did not show any difference between biologics in terms of effectiveness," Dr. Jacques-Eric Gottenberg from Strasbourg University Hospital in France told Reuters Health by email. "Our direct comparison using observational data (and taking into account this important limitation) showed a significantly lower drug retention of abatacept on the one hand, than rituximab and tocilizumab on the other hand."

The non-TNF inhibitors rituximab, abatacept, and tocilizumab are often used in patients who fail to respond to anti-TNF agents, but they have not been compared with each other in randomized controlled trials.

Dr. Gottenberg and colleagues used data from three registries (AIR, ORA, and REGATE) to compare the effectiveness of rituximab, abatacept, and tocilizumab in the treatment of rheumatoid arthritis refractory to TNF inhibitors. The primary outcome was drug retention without failure at 24 months.

At month 24, significantly more patients taking rituximab (68.6%) or tocilizumab (63.4%) than taking abatacept (39.3%) were still using their medication without failure.

Average durations of survival without drug failure were higher for rituximab (19.8 months) and tocilizumab (19.1 months) than for abatacept (15.6 months), and more patients treated with rituximab or tocilizumab than with abatacept showed good or moderate EULAR responses, according to the January 24th online report in BMJ.

The average duration of survival without serious adverse events with similar for the three non-TNF inhibitors.

"Our study concerned longstanding rheumatoid arthritis (median disease duration of around 10 years) in patients previously treated with methotrexate and at least one, frequently two anti-TNFs," Dr. Gottenberg said. "In such a population, the present results suggest that it might be preferable to choose rituximab or tocilizumab rather than abatacept."

"Since some studies reported a better effectiveness of abatacept in recent-onset rheumatoid arthritis, it could be interesting to lead another study comparing these 3 non-TNF-targeted drugs in biologic naive patients with a shorter disease duration," he said.

Bristol-Myers Squibb, Roche, and Chugai provided grants for the three registries, and 10 of the 16 authors reported various relationships with one or more of these companies.

SOURCE: http://bit.ly/2WOVZkK

BMJ 2019.