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.
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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 TNFi).
A majority of participants initiating bDMARD 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 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.