Tocilizumab Effective After Previous Biologic DMARD Failure

Rheumatoid arthritis (RA) patients with a history of inadequate response to at least one biologic may have good biologic persistence with the use of tocilizumab, according to a recent study. The findings were presented at European League Against Rheumatism (EULAR) 2019.

“The EULAR and [American College of Rheumatology] clinical guidelines recommend switching to a different disease-modifying antirheumatic drug (DMARD) when biologic-treated patients experience treatment failure or toxicity,” the researchers wrote in their abstract, adding, “Limited information is available regarding biologic therapy persistence across subcutaneously administered (SC) biologic agents in the real-world setting, as well as for comparative information on biologic persistence for SC biologics among patients with rheumatoid arthritis (RA) who are not naive to biologic treatment.”

Jennie H. Best, PhD, principal health economist with Genentech, Inc., who presented the findings, told DocWire News in an interview that the authors undertook this study because, “Persistence is a proxy for effectiveness. Stakeholders, including payers, are interested in understanding how long patients persist on therapy.”

The researchers reviewed U.S. administrative claims data on adult RA patients initiating an SC biologic between Jan. 1, 2012, and June 30, 2017. Patients were eligible for inclusion if they had previously experienced failure with at least one biologic DMARD (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.

Tocilizumab Comes Out on Top, Abatacept and Golimumab Close Behind

A total of 10,301 patients (mean age, 51 years) were included in the study, with 12,704 bDMARD episodes. The most common bDMARD was adalimumab (n = 3,599); others included abatacept (n = 2,988), certolizumab (n = 982), etanercept (n = 2,760), golimumab (n = 745), and tocilizumab (n = 1,630).

“This study found that patients treated with subcutaneous tocilizumab had similar persistence on therapy to abatacept and golimumab, and significantly longer persistence than adalimumab, certolizumab, and etanercept,” Dr. Best shared.

Tocilizumab users had the highest adjusted median persistence days (333), followed by abatacept (320), golimumab (304), etanercept (289), adalimumab (280), and certolizumab (262).

Among patients who had one year of data available, 55% initiated weekly tocilizumab and the rest initiated bi-weekly tocilizumab (n = 347); during the one-year period of follow-up, 33% of the bi-weekly initiators switched to weekly (mean time to switch, 177 days). At the end of one year, most patients (about 68%) were on weekly dosing.

A limitation of the study was that it only included claims data, so it may not be generalizable to patient without insurance, Dr. Best said.

The authors concluded in their abstract, “Among patients with RA who previously used ≥1 other biologic, tocilizumab-treated patients had similar or statistically significantly better biologic persistence compared with other biologics.”