The impact of patient heterogeneity and socioeconomic factors on abatacept retention in rheumatoid arthritis across nine European countries

Abstract

BackgroundThere are substantial differences in accessibility to biological disease modifying antirheumatic drugs (bDMARDs) across countries. The objective of this study was to analyse the impact of patient demographics, disease characteristics and gross domestic product (GDP) on abatacept (ABA) retention in patients with rheumatoid arthritis (RA) treated in clinical practice.MethodsData from nine European observational RA cohorts of patients treated with ABA were pooled. Kaplan-Meier analysis was used to compare drug retention across registries. Specific causes of drug retention were investigated using competing risks multivariate Cox regression.ResultsA total of 3961 patients treated with ABA, with 6188 patient-years of follow-up, were included. Patients in the different national registries had similar demographic features, but varied in baseline disease characteristics. ABA drug retention differed between countries, with median drug retention rates ranging from 1.2 to more than 6 years. The differences in drug retention were marginally explained by disparities in disease characteristics, while the national GDP per capita was strongly associated with drug retention (correlation coefficient −0.74; p=0.02).ConclusionsPatient characteristics at ABA initiation vary across Europe, probably reflecting differences in eligibility criteria and prescription patterns. However, the difference in ABA drug retention between countries was not primarily explained by disparities in patient characteristics. Lower ABA retention was observed in countries with a more liberal access to bDMARDs and higher GDP. National differences need to be accounted for when pooling data on treatment with bDMARDs from various countries.

Predictors of abatacept retention over 2 years in patients with rheumatoid arthritis: results from the real-world ACTION study

“…In this first real-world study to include a cohort of biologic-naive patients treated with abatacept, higher abatacept retention rates at 2 years were associated with lower previous exposure to biologics: biologic-naive patients showed a retention rate of 55% compared with a rate of 45% in patients with previous biologic failure. This was consistent with findings from independent registry studies for abatacept [21,22] and other biologics [23][24][25][26]. Predictors of abatacept retention were identified using multivariable analysis.…”

“…These differences in retention may reflect national differences in prescribing guidelines; for example, although abatacept monotherapy is approved in Europe and Canada [10,11], clinical guidelines in Germany permit abatacept monotherapy only in patients who are intolerant of methotrexate. Differences in abatacept retention have been observed previously across countries in a pooled analysis of data from European registries and were indicative of a lack of uniformity in access to biologics [22]. Irrespective of regional variations, real-world studies continue to provide valuable data on abatacept for clinicians.…”

Abatacept retention and clinical outcomes in rheumatoid arthritis: real-world data from the German cohort of the ACTION study and a comparison with other participating countries

“…In contrast to findings for the overall ACTION population [8], in the German cohort, there was no significant difference between 2-year retention rates in biologic-naïve versus biologic-failure patients. Prior exposure to biologic agents was also shown to negatively influence abatacept retention in clinical practice by Finckh et al [16]. In this pan-European study, variation in retention was explained primarily by differences in access to bDMARDs, rather than patient or disease characteristics.…”

“…Despite widespread acceptance of EULAR guidelines for the treatment of RA [1,18] at a local level [19], the availability, reimbursement and uptake/treatment patterns of newer agents, particularly bDMARDs, does vary greatly between European countries [20][21][22]. Indeed, lower abatacept retention in countries with greater access to bDMARDs has been described [16], which may partly explain the differences in retention between Germany and other participating countries reported here.…”

“…Variations in abatacept retention rates by country were also reported in an analysis of nine European registries [16]. Geographical differences in retention and response are likely due to numerous factors, including genetic variation [17] and differences in health-care systems.…”