Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study

Abstract

ObjectivesThis study evaluated the comparative effectiveness of a tumour necrosis factor inhibitor (TNFi) versus a non-TNFi (biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs)) as the first-line treatment following conventional synthetic DMARDs, as well as potential modifiers of response, observed in US clinical practice.MethodsData were from a large US healthcare registry (Consortium of Rheumatology Researchers of North America Rheumatoid Arthritis Registry). The analysis included patients (aged ≥18 years) with a documented diagnosis of rheumatoid arthritis (RA), a valid baseline Clinical Disease Activity Index (CDAI) score of >2.8 and no prior bDMARD or tsDMARD use. Outcomes were captured at 1-year postinitiation of a TNFi (adalimumab, etanercept, certolizumab pegol, golimumab or infliximab) or a non-TNFi (abatacept, tocilizumab, rituximab, anakinra or tofacitinib) and included CDAI, 28-Joint Modified Disease Activity Score, patient-reported outcomes (including the Health Assessment Questionnaire Disability Index, EuroQol-5 Dimension score, sleep, anxiety, morning stiffness and fatigue) and rates of anaemia. Groups were propensity score-matched at baseline to account for potential confounding.ResultsThere were no statistically significant differences observed between the TNFi and non-TNFi treatment groups for outcomes assessed, except the incidence rate ratio for anaemia, which slightly favoured the TNFi group (19.04 per 100 person-years) versus the non-TNFi group (24.01 per 100 person-years, p=0.03). No potential effect modifiers were found to be statistically significant.ConclusionsThe findings of no significant differences in outcomes between first-line TNF versus first-line non-TNF groups support RA guidelines, which recommend individualised care based on clinical judgement and consideration of patient preferences.

Value of imaging detected joint inflammation in explaining fatigue in RA at diagnosis and during the disease course: a large MRI study

“…Previous research did not show an effect of individual Disease Modifying Anti-Rheumatic Drugs (DMARDs) on fatigue. 14 However, to ensure our findings over time were not confounded by treatment, we repeated analyses over time in patients receiving initial methotrexate therapy since this was the most frequently occurring initial treatment (69%).…”

Response to ‘Correspondence on ‘Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study’’ by Zhenget al

“…Response to 'Correspondence on 'Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study'' by Zheng et al We thank Zheng et al 1 for their interest in our study 2 and for providing constructive comments. They mention that even though the baseline mean Clinical Disease Activity Index (CDAI) was not statistically different, the proportion of patients with moderate or high disease at baseline was different and this could have been a key effect modifier.…”

“…1 In our study, coexisting csDMARD use was considered only at baseline, but not during follow-up. 2 Prior csDMARD use was also evaluated. Changes in concurrent DMARD therapy over the follow-up period were not evaluated.…”

“…Smoking and baseline anaemia were considered as effect modifiers and were not found to be significantly associated with the outcome as described in the 'Determination of effect modifiers' section of the Methods. 2 Although uncommon, some rheumatologists prescribe anakinra. We believe that the small number of patients on anakinra (14 patients among thousands in the 2 cohorts) did not affect the findings and would not alter the results if removed from the analysis.…”

Correspondence to ‘Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study’

“…We read with great interest the article by Pappas et al 1 who evaluated the comparative effectiveness of a tumour necrosis factor inhibitor (TNFi) such as adalimumab, etanercept, certolizumab pegol, golimumab or infliximab versus a non-TNFi (abatacept, tocilizumab, rituximab, anakinra or tofacitinib) as the first-line treatment in patients with rheumatoid arthritis (RA). The authors concluded that there were no statistically significant differences observed between the TNFi and non-TNFi treatment groups for the outcomes assessed, including the Clinical Disease Activity Index (CDAI), the 28-Joint Modified Disease Activity Score, the Health Assessment Questionnaire Disability Index, EuroQol-5 Dimension score, morning stiffness and fatigue.…”