Rheum Round-up: Fibromyalgia Med Tied to Suicidal Behavior, Abatacept Compared to Other DMARDs, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read about the link between a fibromyalgia medication and suicidal behavior, how abatacept compares to other disease-modifying antirheumatic drugs (DMARDs), the effectiveness of repository corticotropin injection in rheumatoid arthritis (RA), and the use of tocilizumab to treat RA after previous DMARD failure.

A recent study found an association between gabapentinoids and an increased risk of suicidal behavior, unintentional overdoses, head/body injuries, and road traffic incidents/offenses. There are two main gabapentinoids—gabapentin and pregabalin (including the popular drug Lyrica). Pregabalin is used to treat fibromyalgia in the United States. The drugs have become increasingly more popular and are currently one of the world’s top 15 drugs for revenue. For the study, researchers queried the Swedish Prescribed Drug Register for data on patients who filled at least two consecutive prescriptions for pregabalin or gabapentin between 2006 and 2013. The primary study outcomes included suicidal behavior, unintentional overdoses, head/body injuries, road traffic incidents/offenses, and violent crime arrests. Of the 191,973 patients included in the final analysis, 10,026 (5.2%) were treated for suicidal behavior or committed suicide. In total, 70,522 patients (36.7%) sustained head/body injuries, 17,144 (8.9%) had an unintentional overdose, 12,070 (6.3%) had a road traffic incident/offense, and 7,984 (4.1%) committed a violent crime and were arrested.

A comparison of abatacept (ORENCIA) and other biologic (b) disease-modifying antirheumatic drugs and conventional synthetic (cs)DMARDs in patients with rheumatoid arthritis (RA) found no significant safety differences. RA patients aged ≥ 18 years registered with FORWARD—an ongoing, longitudinal, prospective, observational, U.S.-based study—were included in the analysis. Patients had to be initiators of abatacept, other bDMARDs (adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab), or csDMARDs (methotrexate, hydroxychloroquine, leflunomide and sulfasalazine) between 2005 and 2015. If a patient changed treatment course during the study, they could be part of multiple groups. There were 1,496 abatacept initiators, 3,490 patients starting another bDMARD, and 1,520 csDMARD initiators. There were no significant differences in risk of malignancies for abatacept patients compared to those initiating other bDMARDs or csDMARDs. Abatacept patients had a lower risk of hospitalized infections than those taking other bDMARDs. All three groups had similar risks for psoriasis. The abatacept group, compared to the other bDMARDs group, had a significantly lower risk for severe infusion/injection reactions.

And in RA cases where DMARDs fail, patients may have an alternative option: repository corticotropin injection (RCI), research suggests. The study, “A Multicentre Study Assessing the Efficacy and Safety of Repository Corticotropin Injection in Patients With Persistently Active Rheumatoid Arthritis,” had two parts: a 12-week open-label RCI treatment period, followed by a 12-week double-blind, placebo-controlled, randomized withdrawal period for the patients who achieved low disease activity (LDA) in part one. There were 259 patients (mean ag, 51 years) in the open-label portion of the study. Mean disease activity score with a 28 joint count and erythrocyte sedimentation rate (DAS28-ESR) at baseline was 6.3, and mean ESR was 43.6; 12 weeks later, the mean values were 3.6 and 24, respectively, with 63% of patients achieving LDA. After the open-label period, the remaining patients were divided into two groups: RCI and placebo. After part two concluded, the rate of cumulative disease activity flare in the RCI group (17.05%) was about half that of the placebo group (29.73%), and significantly more RCI patients achieved LDA compared to placebo (86% vs. 66%).

And in the face of failure of bDMARDs, RA patients may have good biologic persistence with tocilizumab, a new study found. The study assessed U.S. administrative claims data on RA patients who initiated a subcutaneously administered biologic between Jan. 1, 2012, and June 30, 2017, after previous failure with at least one bDMARD. The primary outcome was biologic persistence, which was defined as the number of days between initiating therapy and last supplied day of last fill. Researchers compared outcomes associated with tocilizumab use versus other biologics. A total of 10,301 patients (mean age, 51 years) were included in the study, with 12,704 bDMARD episodes. Tocilizumab users had the highest adjusted median persistence days (333). Among patients who had one year of data available, 55% initiated weekly tocilizumab and the rest initiated bi-weekly tocilizumab; during the one-year period of follow-up, 33% of the bi-weekly initiators switched to weekly. At the end of one year, most patients (about 68%) were on weekly dosing.