“Previously, indirect comparisons (meta-analyses) did not show any difference between biologics in terms of effectiveness,” Dr. Jacques-Eric Gottenberg from Strasbourg University Hospital, France, tells Reuters Health by email. “Our direct comparison using observational data (and taking into account this important limitation) showed a significantly lower drug retention of abatacept on the one hand, than rituximab and tocilizumab on the other hand.”
The non-TNF inhibitors rituximab, abatacept and tocilizumab are often used in patients who fail to respond to anti-TNF agents, but they have not been compared with each other in randomized controlled trials.
Dr. Gottenberg and colleagues used data from three registries (AIR, ORA and REGATE) to compare the effectiveness of rituximab, abatacept and tocilizumab in the treatment of RA refractory to TNF inhibitors. The primary outcome was drug retention without failure at 24 months.
At Month 24, significantly more patients taking rituximab (68.6%) or tocilizumab (63.4%) than taking abatacept (39.3%) were still using their medication without failure.
Average durations of survival without drug failure were higher for rituximab (19.8 months) and tocilizumab (19.1 months) than for abatacept (15.6 months), and more patients treated with rituximab or tocilizumab than with abatacept showed good or moderate EULAR responses, according to the Jan. 24 online report in BMJ.1
The average duration of survival without serious adverse events with similar for the three non-TNF inhibitors.
“Our study concerned longstanding rheumatoid arthritis (median disease duration of around 10 years) in patients previously treated with methotrexate and at least one, frequently two anti-TNFs,” Dr. Gottenberg says. “In such a population, the present results suggest that it might be preferable to choose rituximab or tocilizumab rather than abatacept.”
“Since some studies reported a better effectiveness of abatacept in recent-onset rheumatoid arthritis, it could be interesting to lead another study comparing these three non-TNF-targeted drugs in biologic naive patients with a shorter disease duration,” he says.
Bristol-Myers Squibb, Roche and Chugai provided grants for the three registries, and 10 of the 16 authors reported various relationships with one or more of these companies.
- Gottenberg JE, Morel J, Perrodeau E, et al. Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study. BMJ. 2019 Jan 24;364:l67.