Factors that Influence Biologic Therapy Choices for Patients with Rheumatoid Arthritis

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Recent research analyzed factors influencing the selection of the first-line biologic medications and the real-life factors that lead to switching from those medications to other biologics in treating rheumatoid arthritis (RA). The study compared the use of abatacept and tocilizumab with a tumor necrosis factor alpha inhibitor (TNFi).^1,2 Participants were enrolled in the Lombardy Rheumatology Network (LORHEN) after Jan. 1, 2010, and were treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) at eight rheumatology centers in Northern Italy.

The study population (n=1,910) was divided into first- and second-line bDMARD treatment groups, with 1,264 first-line patients (115 received abatacept, 130 received tocilizumab and 1,019 received a TNFi) and 646 second-line patients (143 received abatacept, 97 received tocilizumab and 406 received a TNFi).

A majority of participants initiating bDMARDs received a TNFi. Comorbidities that influenced the choice toward abatacept and tocilizumab compared with a TNFi were categorized by organ system groups: arterial hypertension, cardiovascular disease, diabetes mellitus, dyslipidemia, osteoporosis, peripheral neuropathy, pulmonary disease, thyroid autoimmune disease and other comorbidities not belonging to the prior categories.

In general, older patients were more likely to be prescribed abatacept and tocilizumab compared with patients receiving a TNFi (P<0.0001). A higher prevalence of positive latent tuberculosis infection (LTBI) was associated with abatacept (30%) than with tocilizumab (16%) or TNFi (16%). Combination treatment with methotrexate was lower in tocilizumab-treated patients.

Analysis showed a prevalence of prescribing abatacept in patients who were receiving it as a second-line treatment; were older; had dyslipidemia, pulmonary disease or other comorbidities; and had extra-articular manifestations of RA. Use of tocilizumab was linked to second-line treatment, older age and more severe disease activity. If the first bDMARD was stopped due to an adverse event, this factor influenced a subsequent treatment choice toward abatacept.

In this study, older age and comorbidities influenced changing treatment to abatacept and tocilizumab vs. a TNFi. After patients initially failed first-line treatment with a TNFi, switching to an agent with a different mechanism of action was more widespread.

Insights into Drug-Related Interactions in Older Adults

In a recent cross-sectional study, researchers evaluated the prevalence of possible drug–disease and drug–drug interactions and associated variables in community-dwelling older adults.³ Patients aged 70–79 years (n=3,055) without mobility limitation at their baseline visit in the Health Aging and Body Composition Study were enrolled in this study.

Outcome factors were potential drug–disease and drug–drug interactions identified by using particular criteria from various sources, as well as self-reported nonprescription and prescription drug use. Explicit criteria for 70 potential drug–drug interactions developed by geriatric experts and reactions found to be a cause for drug-related hospitalizations were used.