Background
Abatacept is a biologic therapy which suppresses T-cell activation via co-stimulation blockade in rheumatoid arthritis (RA) patients. It became part of our biologic algorithm shortly after initial limited NICE approval in August 2010. In April 2013, NICE widened its recommendation of abatacept in RA patients who have failed to respond adequately to 2 disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate [2].
Objectives
In this study we share our experience of abatacept in patients with rheumatoid arthritis (RA) in routine clinical practice from a subregional centre in UK covering a population of 500,000.
Methods
This was a retrospective analysis of 84 patients who received abatacept therapy from November 2010 to January 2014. Data collected included baseline demographics, number of previous synthetic and biologic DMARDs, change in DAS28 at 3 and 6 months. Response was defined as DAS28 reduction of greater than 1.2.
Results
84 patients with RA were commenced on abatacept therapy over 39 months since Nov 2010. The mean age of the patients was 62 years and 74% of them were female. The average number of prior synthetic DMARDs was 2.8 and biologic DMARDs 2.1. Only 2 patients were biologic- naïve before abatacept. 75 patients had received anti-TNF therapy (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), 40 had received rituximab and 7 tocilizumab.
The baseline DAS28 was 5.8 and mean DAS reduction at 3 and 6 months was 1.6 (n=41) and 2.0 (n=37) respectively. 25 out of 41 (61%) patients responded at 3 months and this increased to 76% at 6 months (28/37). 14% (5/37) achieved remission at 6 months. 11 patients stopped abatacept therapy, 5 were intolerant of which 3 had infusion reactions, 1 patient had lack of efficacy and 2 loss of efficacy (between 3 and 6 months), 1 patient refused further infusions and 2 patients moved out of area. In a subgroup, the mean DAS reduction at 6 months in seropositive (Rheumatoid Factor or Anti-CCP antibody positive n=14) and seronegative patients (n=16) were 2.54 and 1.88 respectively.
Conclusions
Our experience shows that abatacept is safe, well tolerated and effective in RA patients with inadequate response to previous synthetic and biologic DMARDs in routine clinical practice. The improvement in DAS28 at 3 months was sustained at 6 months. The numbers are small to draw any conclusion about better response in seropositive RA patients.
References
NICE recommends wider use of abatacept for treating rheumatoid arthritis (Guidance TA195) August 2010
NICE technology appraisal guidance: Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (Guidance TA280 rapid review of TA234) April 2013
Acknowledgements
We would like to thank all members of the Rheumatology team at Cannock Hospital and the patients who participated.
Disclosure of Interest
None declared
DOI
10.1136/annrheumdis-2014-eular.3037
OBJECTIVES:In the UK, access to anti-TNF therapies for the treatment of rheumatoid arthritis (RA) is standardized by National Institute for Clinical Excellence guidance. Certolizumab pegol (CZP) studies in RA demonstrate that patient response to therapy at 12 weeks predicts clinical outcome at 1 year. In the UK, CZP is available via a Patient Access Scheme (PAS), providing CZP free for the first 12 weeks. This analysis examines persistency and potential cost savings realised with a 12 week CZP decision. METHODS: A retrospective analysis examined 2,744 patients receiving CZP between March 2010 and March 2012 from Healthcare at Home, a UK home health care service provider. Persistence was defined as patients (%) continuing to receive CZP deliveries, calculated at specific time points. Treatment start was first delivery date and patients were censored according to this. A simple cost analysis was performed. RESULTS: At 13, 26, 39 and 52 weeks, persistence rates were 93%, 79%, 70% and 65% in naive (no prior anti-TNF) and 88%, 68%, 56% and 48% in switch (Ն1 prior anti-TNF) patients respectively. Analyzing first-line biologic drug costs only, the NHS would save £2,363.14/patient in the first year if CZP were used instead of adalimumab (assuming similar persistence); largely due to the PAS. Stopping treatment for non-responders at Week 12 (CZP) vs Week 24 (adalimumab), could allow the UK NHS to re-invest £ 2145/patient. CONCLUSIONS: In this UK cohort, CZP persistence was higher in naive pts. Reinforcing a 12 week treatment decision could result in more efficient spend on drugs and rapid initiation of alternative treatment in non-responders.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.