SAN FRANCISCO, CA—There were no major differences in efficacy, clinical outcomes, and time to response among adalimumab, abatacept, etanercept, and infliximab in the treatment of rheumatoid arthritis (RA), reported lead study author Yusuf Yazici, MD, from New York School of Medicine, Department of Medicine, Division of Rheumatology, New York, NY, at the 2015 ACR/ARHP Annual Meeting.

“With no difference in clinical outcomes, most treatment decisions may be based on ease of use and safety data of respective biologic agents when they are being considered for RA treatment,” Dr. Yazici reported.

Multiple biologic agents with varying modes of action are available for the treatment of RA. The absence of head-to-head clinical trials present difficulty for physicians to compare the clinical outcomes of these RA agents. Dr. Yazici and his team set out to examine the comparative effectiveness and time to response among abatacept, adalimumab, certolizumab, etanercept, infliximab, rituximab, and tocilizumab, using a real-world routine care registry.

Data from the Arthritis Registry Monitoring Database (ARMD) was used for patient inclusion and analysis. ARMD collects prospective patient data including health assessment scales (physical function, pain, patient global estimate, fatigue, self-report RADAI painful joint count), self-reported disease activity, and biologic treatments received. Time to first response, defined as an improvement in routine assessment of patient index data 3 (RAPID3) of ≥3.6 units, was calculated, and change from biologic treatment initiation to first response was estimated. Lack of efficacy was defined as no response after time to last follow-up was calculated.

A total of 1,789 treatment observations in 316 patients were included for analysis. Using infliximab as a reference, improved efficacy was estimated with abatacept (SHR [subhazard ratio]=1.5), etanercept (SHR=1.6) and rituximab (SHR=2.3), adjusting for age, duration and baseline RAPID3, Dr. Yazici reported. 

“Adalimumab and tocilizumab had some improved efficacy compared to infliximab, while certolizumab estimated to have decreased efficacy compared to infliximab,” Dr. Yazici noted.