Nobunori Takahashi1, Toshihisa Kojima2, Daihei Kida3, Atsushi Kaneko3, Yuji Hirano4, Takayoshi Fujibayashi5, Yuichiro Yabe6, Hideki Takagi7, Takeshi Oguchi8, Masahiro Hanabayashi9, Takefumi Kato10, Koji Funahashi11, Masatoshi Hayashi12, Seiji Tsuboi13, Yasuhide Kanayama14, Yasumori Sobue2, Nobuyuki Asai2, Takuya Matsumoto2, Tatsuo Watanabe2, Shuji Asai2, Naoki Ishiguro2. 1. Department of Orthopedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. nobunori@med.nagoya-u.ac.jp. 2. Department of Orthopedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. 3. Department of Orthopedic Surgery and Rheumatology, Nagoya Medical Center, 4-1-1 Sanno-maru, Naka-ku, Nagoya, Aichi, Japan. 4. Department of Rheumatology, Toyohashi Municipal Hospital, 50 Hakken-nishi, Aotake-cho, Toyohashi, Aichi, Japan. 5. Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Oomatsubara, Takaya-cho, Konan, Aichi, Japan. 6. Department of Rheumatology, Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, Japan. 7. Department of Orthopedic Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Aichi, Japan. 8. Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihirokute, Anjo, Aichi, Japan. 9. Department of Orthopedic Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi, Japan. 10. Kato Orthopedic Clinic, 8-4 Minami-myoudaiji-cho, Okazaki, Aichi, Japan. 11. Department of Orthopedic Surgery, Kariya-Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, Japan. 12. Department of Rheumatology, Nagano Red Cross Hospital, 5-22-1 Wakazato, Nagano, Japan. 13. Department of Orthopedic Surgery, Shizuoka Kosei Hospital, 23 Kitaban-cho, Aoi-ku, Shizuoka, Japan. 14. Department of Orthopedic Surgery, Toyota Kosei Hospital, 500-1 Ibohara Josui-cho, Toyota, Aichi, Japan.
Abstract
OBJECTIVE: To compare the clinical outcomes of abatacept between rheumatoid arthritis patients with and without concomitant methotrexate (MTX) treatment in daily clinical practice. METHODS: A retrospective cohort study was performed using data from a multicentre registry. A total of 176 consecutive rheumatoid arthritis patients treated with abatacept were included. The propensity score based on multiple baseline characteristic variables was calculated, and 41 of 86 patients treated without MTX (MTX(-)) and 41 of 90 patients treated with concomitant MTX (MTX(+)) were statistically extracted and analysed. Clinical outcomes were evaluated and compared between the two groups over a 52-week period. RESULTS: Baseline characteristics were statistically comparable. No significant differences were observed in the following clinical outcomes from baseline throughout the 52-week period: drug retention rate (MTX(-)/MTX(+) 79.1%/80.5%), mean change in disease activity score based on 28 joints (DAS28-CRP) from baseline (- 1.35/- 1.54), low disease activity rate (48.8%/43.9%), clinical remission rate (31.7%/36.6%), moderate European League Against Rheumatism (EULAR) response rate (68.3%/68.3%), and good EULAR response rate (36.6%/41.1%) at 52 weeks. CONCLUSION: In rheumatoid arthritis patients with similar background characteristics undergoing abatacept treatment, concomitant MTX does not seem to affect clinical outcomes. Abatacept would be a suitable treatment option in daily clinical practice in patients with contraindications to MTX. KEY POINTS: • This is the first study to directly compare the clinical efficacy and safety of abatacept between patients with and without concomitant methotrexate (MTX) treatment in 'real-world' settings using the propensity score matching method. • There were no significant differences in clinical outcomes of abatacept between patients with and without concomitant MTX treatment. • We used data from a large Japanese multicentre registry for biologics in rheumatoid arthritis, thereby decreasing selection bias based on the personal preferences of physicians.
OBJECTIVE: To compare the clinical outcomes of abatacept between rheumatoid arthritispatients with and without concomitant methotrexate (MTX) treatment in daily clinical practice. METHODS: A retrospective cohort study was performed using data from a multicentre registry. A total of 176 consecutive rheumatoid arthritispatients treated with abatacept were included. The propensity score based on multiple baseline characteristic variables was calculated, and 41 of 86 patients treated without MTX (MTX(-)) and 41 of 90 patients treated with concomitant MTX (MTX(+)) were statistically extracted and analysed. Clinical outcomes were evaluated and compared between the two groups over a 52-week period. RESULTS: Baseline characteristics were statistically comparable. No significant differences were observed in the following clinical outcomes from baseline throughout the 52-week period: drug retention rate (MTX(-)/MTX(+) 79.1%/80.5%), mean change in disease activity score based on 28 joints (DAS28-CRP) from baseline (- 1.35/- 1.54), low disease activity rate (48.8%/43.9%), clinical remission rate (31.7%/36.6%), moderate European League Against Rheumatism (EULAR) response rate (68.3%/68.3%), and good EULAR response rate (36.6%/41.1%) at 52 weeks. CONCLUSION: In rheumatoid arthritispatients with similar background characteristics undergoing abatacept treatment, concomitant MTX does not seem to affect clinical outcomes. Abatacept would be a suitable treatment option in daily clinical practice in patients with contraindications to MTX. KEY POINTS: • This is the first study to directly compare the clinical efficacy and safety of abatacept between patients with and without concomitant methotrexate (MTX) treatment in 'real-world' settings using the propensity score matching method. • There were no significant differences in clinical outcomes of abatacept between patients with and without concomitant MTX treatment. • We used data from a large Japanese multicentre registry for biologics in rheumatoid arthritis, thereby decreasing selection bias based on the personal preferences of physicians.