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Drug Retention in RA: The Long and Winding Road

November 15 2016 12:00 PM ET via RheumReports RheumReports

Patients often ask, (especially when they have previously tried several RA medications) how long will this drug last? The answer is complex and is often hedged with statements such as "It depends." In general, we do not have RCTs comparing drug retention on one drug versus another, or even one strategy to another since eventually the trial ends (often in 1 to 2 years) and even for treatment strategies, the protocols change to real-world choices over time. 

What we can say is that if treating to a target, some drugs may last longer and front-end loading strategies ma;y give faster and sometimes longer disease control. So we turn to registries to answer these questions. For sure if you get a rapid and deep remission response to a drug, it will last longer. So the answer is individualized and better answered 3 months after starting a new drug. 

At this ACR meeting, 3 French databases were combined to study retention rates of abatacept (ABA), rituximab (RTX) and tocilizumab (TCZ) in nearly 4500 RA patients (Gottenberg JE et al, Abstract #1998). Nearly 1/3 of patients were on each of the above drugs as monotherapy (a bit more with TCZ, where 40% were on monotherapy). For RTX, 2/3 were still on drug at 2 years and half remained on drug at 5 years with background DMARD(s) and 45% on monotherapy. For ABA, retention was lower at 2 years (43% with DMARD(s) and 37% without DMARD(s)) and at 5 years with 23% in combination and 19% with monotherapy. For TCZ at 2 years, retention was 66% on combination and 61% on monotherapy.

Although the P-values were not significant, retention rates were in general slightly higher on combination therapy. This study did not compare disease activity between combination and monotherapy. There were between-drugs difference in retention rates and that could be due to confounding – these are observational data and not from a RCT, so there may be differences in the baseline characteristics of the groups.

So, there is a long and winding road of understanding drug retention in RA and this abstract helps to inform us of the 2- to 5-year retention rates of non-TNFi biologics.


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About the Author

Dr. Janet Pope
Dr. Janet Pope

Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.

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