Peter Youssef1, Bruno Marcal1, Peter Button1, Matt Truman1, Paul Bird1, Hedley Griffiths1, Lynden Roberts1, Kathleen Tymms1, Geoff Littlejohn1. 1. From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia. This study was supported by Roche Products Pty Ltd. (Australia). B.M. is an employee of Roche Products Pty Ltd. and reports stock ownership at Roche. P.B. was an employee of Roche Products Pty Ltd. until December 2017 and then worked as a consultant statistician during the conduct of the study. M.T. was an employee of Roche Products Pty Ltd. until December 2017 and then worked as a consultant statistician during the conduct of the study; and he reports stock ownership at Roche. P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University. Address correspondence to Prof. P. Youssef, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia. E-mail: pyoussef@med. usyd.edu.au. Accepted for publication November 20, 2019.
Abstract
OBJECTIVE: To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi). METHODS: This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation. RESULTS: Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was "lack of efficacy" (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27-74). CONCLUSION: A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.
OBJECTIVE: To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi). METHODS: This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation. RESULTS: Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was "lack of efficacy" (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27-74). CONCLUSION: A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.
Authors: Theresa Burkard; Ross D Williams; Enriqueta Vallejo-Yagüe; Thomas Hügle; Axel Finckh; Diego Kyburz; Andrea M Burden Journal: Rheumatol Adv Pract Date: 2021-11-13
Authors: Theresa Burkard; Enriqueta Vallejo-Yagüe; Thomas Hügle; Axel Finckh; Andrea Michelle Burden Journal: BMJ Open Date: 2022-03-15 Impact factor: 2.692