medwireNews: Findings from two real-world studies suggest that rheumatoid arthritis (RA) patients treated with tumor necrosis factor (TNF) inhibitors experience similar clinical outcomes and rates of discontinuation to those given other biologics or Janus kinase (JAK) inhibitors.
In the first study, Dimitrios Pappas (Columbia University Medical Center, New York, USA) and colleagues used the Corrona registry to evaluate the outcomes of RA patients who initiated treatment with a first biologic or JAK inhibitor in the USA between 2001 and 2018.
The team found that measures of clinical response at 1 year were not significantly different among the 2372 patients taking a TNF inhibitor and the 593 propensity score-matched patients who were instead taking a non-TNF inhibitor biologic or tofacitinib.
For instance, rates of low disease activity (CDAI ≤10) at 1 year were 39.9% for the TNF inhibitor group and 41.6% for the non-TNF inhibitor group, while the corresponding rates of remission (CDAI ≤2.8) were 17.6% versus 16.3%. Sleep problems were reported by 23.3% and 23.0% of patients, respectively.
Pappas et al note that the incidence rate ratio for anemia “slightly favoured” the TNF inhibitor group (19.04 vs 24.01 per 100 person–years). However, they say that this result is “largely inconclusive” because “a large body of evidence supports the association between IL [interleukin]-6 inhibitors and increased haemoglobin levels in patients with RA, with JAK inhibitors having a neutral association,” but there was “disproportionately low usage of IL-6 and JAK inhibitor treatments in this study.”
Together, the study results “support RA guidelines which recommend individualised care based on clinical judgement and consideration of patient preferences,” concludes the team in the Annals of the Rheumatic Diseases.
The second study, published in Seminars in Arthritis & Rheumatism, included 932 RA patients from Ontario, Canada, who initiated a biologic therapy between 2010 and 2019, with 81.3% commencing a TNF inhibitor and 18.7% a non-TNF inhibitor biologic.
During a median follow-up of 1.7 years, 44.6% of the total study population discontinued their biologic agent, giving an overall incidence rate for discontinuation of 18.4 per 100 person–years.
Claire Bombardier (University Health Network, Toronto, Ontario) and colleagues report that the incidence rate of discontinuation due to any reason was numerically lower among patients in the TNF inhibitor group than those in the other biologics group (17.4 vs 23.7 per 100 person–years), but there was no significant between-group difference after adjustment for potentially confounding factors.
Comparable rates of discontinuation of TNF inhibitors versus other biologics were also seen when different reasons for discontinuation – including lack or loss of response and adverse events – were analyzed separately.
The researchers conclude that the “reason for [biologic] discontinuation may be independent of drug class” among patients with RA, and “should not drive the selection of one treatment over another.”
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Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217209
Semin Arthritis Rheum 2020; doi:10.1016/j.semarthrit.2020.06.020