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. (June 2019) - Chatzidionysiou, Katerina
Abstract : Background: The optimal sequencing of biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) in Rheumatoid Arthritis (RA) is unknown. Evidence regarding the effectiveness of a 2 nd non-TNFi bDMARD, as well as of TNFi, in patients whose 1 st bDMARD has been a non-TNFi is limited. Objectives: To characterize patients switching for medical reasons after failure of a non-TNFi used as 1 st bDMARD, and to assess the effectiveness of rituximab (RTX), abatacept (ABA) or tocilizumab (TCZ) vs. a TNFi. Methods: Patients from 5 national registers (Sweden, Norway, Denmark, Iceland and Finland) with RA who started treatment with a non-TNFi as a 1 st bDMARD after 2010 and switched to a 2 nd bDMARD within 3 months after the discontinuation of the 1 st (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. Results: 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 nd bDMARD at 6 months after switch. Conclusion: The six-month drug retention for a 2 nd bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as 1 st 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. Acknowledgement: The study was partly funded by a study grant from NordForsk and Foreum. Disclosure of Interests: 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.