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Rhumadata® Posters Presented at the 2015 American College of Rheumatology Meeting (San Francisco)
DISEASE AND TREATMENT CHARACTERISTICS THAT MIGHT INFLUENCE LONG-TERM RETENTION WITH BIOLOGICS IN THE REAL-WORLD CLINICAL SETTING: EXPERIENCE FROM THE RHUMADATA CLINICAL DATABASE AND REGISTRY
Patient adherence and sustainability of the regimen plays an important role in the long-term outcomes. Biologic disease-modifying antirheumatic drugs (bDMARDs) have revolutionized the treatment of rheumatoid arthritis (RA), yet drug discontinuation is common. We aim to investigate factors that might influence long-term retention with biologics in RA.
SIX-YEAR RETENTION RATES WITH ABATACEPT VS TNF INHIBITORS IN THE TREATMENT OF RHEUMATOID ARTHRITIS: EXPERIENCE FROM THE REAL-WORLD RHUMADATA CLINICAL DATABASE AND REGISTRY
The sustainability of the regimen is an important factor to consider when selecting therapy for chronic conditions, such as rheumatoid arthritis(RA). Recent reports suggest that patients (pts) treated with abatacept (ABA) might have better retention rates than those treated with anti-TNFs. We aim to further assess long-term retention rates of ABA in comparison with anti-TNFs in the first and second lines of treatment.
ACR 2015-ABA and TNFi 6-year retention rates in first and second intention
USE OF RITUXIMAB COMPARED TO ANTI-TNF AGENTS AS SECOND AND THIRD LINE THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS. A 6-YEAR FOLLOW-UP REPORT FROM THE RHUMADATA® CLINICAL DATABASE AND REGISTRY
The order of use of biologic agents after failing a TNF inhibitor is still a question for debate. Phase III trial data in TNF-IR patients show comparable efficacy results across biologic agents and limited head-to-head studies have been published. Prospective registries offer a unique opportunity to observe the effectiveness (combined evaluation of efficacy and safety profile over time) of these agents in a real-world clinical setting where all patients with a specific diagnosis and treated in the center are included. We report here a sixth-year follow-up analysis. Our objective is to evaluate if patients with rheumatoid arthritis (RA) treated with rituximab (RIT) after failing a first or a second anti-TNF agents (TNF-IR) have different six -year retention rate than patients similarly prescribed anti-TNF agents (pooled adalimumab, etanercept or infliximab) and compare the treatment strategies of using RIT as second or third biologic treatment.
ACR 2015-Use of rituximab and TNFi in second and third intention 6-year follow-up
COMPARATIVE 10-YEAR RETENTION RATE OF ADALIMUMAB USED IN MONOTHERAPY AND COMBINATION THERAPY IN RHEUMATOID ARTHRITIS (RA) PATIENTS FROM THE RHUMADATA CLINICAL DATABASE AND REGISTRY
The recent publication of the CONCERTO trial comparing the use of adalimumab in monotherapy versus in association with methotrexate (MTX) at dose varying from 2.5 to 20 mg weekly increased the awareness of the importance of anti-drug antibody in lowering the efficacy of adalimumab in patients with RA. Rhumadata®, a real life clinical database and registry, gives a unique opportunity to compare the two strategies over 10 years of treatment. Our objective is to evaluate the impact the combination of MTX over monotherapy on long-term retention rate of adalimumab in a population of patients with RA.
ACR 2015-Comparative 10-year retention rate of ADA used in mono and combination therapy
ETANERCEPT HAS A BETTER RETENTION RATE AT 10 YEARS THAN ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS. RESULTS FROM RHUMADATA® A REAL LIFE CLINICAL DATABASE AND REGISTRY
Very few studies have compared different agents used in the treatment of rheumatoid arthritis (RA) over the very long term, up to 10 years. The vast majority of them have a duration of less than 3 to 4 years, are open-label, have selection entry criteria, and compare outcome measures such as DAS score, DAS improvement, HAQ improvement and so on. Rhumadata, a real life database and registry, enrolling all patients in a given center for whom a specific diagnosis such as RA has been posed, give a unique opportunity to compare retention rates in a large population of patients and analyze variables as predictors of retention. Our objectives are to compare the retention rate of adalimumab and etanercept after DMARDs failure in a population of RA patients and identify potential predictors of retention rate.
ACR 2015-10-year retention of ETA and ADA used in first intention
Club de lecture en rhumatologie
Voici la liste des articles pour le « Journal Club » animé par le Dr D Choquette le 15 mai 2015. Vous avez en même temps accès aux différents posters présentés à ce jour.
Ann Rheum Dis-2015-Neovius-354-60
Ann Rheum Dis-2015-Krieckaert-361-8
Ann Rheum Dis-2015-Kneepkens-396-401
Ann Rheum Dis-2015-Harrold-430-6
RHUMADATA posters presented at the 2015 CRA annual meeting
List of RHUMADATA posters presented at the 2015 CRA meeting held in Quebec city. To download a PDF copy of a poster simply click on the appropriate link.
1. TOCILIZUMAB USE IN DAILY PRACTICE FOR PATIENTS WITH RHEUMATOID ARTHRITIS: PATIENT PROFILE USING THE PROVINCIAL ELECTRONIC DATABASE AND REGISTRY RHUMADATA®.
OBJECTIVES: We report here the profile of patients having started this therapy at the Institut de Rhumatologie de Montréal and the Centre de Rhumatologie et Ostéoporose de Québec that were included in the RHUMADATA® prospective database.
CRA 2015-040-Profile of use of Tocilizumab in daily practice in patients with RA
2. USE OF RITUXIMAB COMPARED TO ANTI-TNF AGENTS AS SECOND AND THIRD LINE THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS. A REPORT FROM THE RHUMADATA® CLINICAL DATABASE AND REGISTRY.
OBJECTIVES: To evaluate if patients with rheumatoid arthritis (RA) treated with rituximab (RIT) after failing a first or a second anti-TNF agents (TNF-IR) have a different drug retention rate than patients similarly prescribed anti-TNF agents (pooled adalimumab, etanercept or infliximab) and compare the treatment strategies of using RIT as second or third biologic treatment.
CRA 2015-041-Use of rituximab as second line biologic agent
3. USE OF MONOTHERAPY ANTI-TNF AGENTS IN ANKYLOSING SPONDYLITIS PATIENTS FROM THE RHUMADATA® REGISTRY: 8-YEAR COMPARATIVE EFFECTIVENESS OF ADALIMUMAB, ETANERCEPT AND INFLIXIMAB.
OBJECTIVES: To assess the retention rates of adalimumab (ADA), etanercept (ETA) and infliximab (INF) in patients diagnosed with ankylosing spondylitis (AS) and to compare patient reported response over time.
CRA 2015-043-Use of monotherapy anti-TNF agents in AS
4. TOCILIZUMAB USE IN PATIENTS WITH RHEUMATOID ARTHRITIS HAVING FAILED ONE PREVIOUS ANTI-TNF AGENT: COMPARISON WITH ADALIMUMAB, ETANERCEPT AND INFLIXIMAB FROM THE PROVINCIAL ELECTRONIC DATABASE AND REGISTRY RHUMADATA®.
OBJECTIVES: The goal of this analysis is to describe the effectiveness of tocilizumab in patients with RA failing a first anti-TNF DMARDs and to compare its retention rate versus adalimumab, etanercept and infliximab in the same clinical situation.
CRA 2015-044-Tocilizumab use in patients with rheumatoid arthritis
5. DISEASE ACTIVITY SCORING: COMPARING PATIENT AND PHYSICIAN GLOBAL ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS STARTING A FIRST BIOLOGIC AGENT.
OBJECTIVES: We hypothesized that while absolute values of patient and physician global disease activity do not always correlate, changes in these measures may offer a better correlation. To this end, we looked at global evaluation changes before and after introduction of a first biologic agent in patient with RA.
CRA 2015-046-Disease activity scoring-comparing patient to physician global
6. PROFILES OF SWITCHES IN PATIENT WITH ANKYLOSING SPONDYLITIS: COMPARING ADALIMUMAB, ETANERCEPT, INFLIXIMAB, GOLIMUMAB AND CERTOLIZUMAB.
OBJECTIVES: The goal of this analysis is to explore the first 6, 12 and 18 month period after first exposure to an initial agent and assess the cycling incidence from different anti-TNF agents namely adalimumab (ADA), etanercept (ETA), infliximab (INF), golimumab (GOL) or certolizumab (CERTO) in AS patients.
CRA 2015-047-Profiles of switches in patients with AS
7. DOES COMBINING METHOTREXATE TO ETANERCEPT IMPROVE ITS RETENTION RATE IN PATIENT WITH EARLY RHEUMATOID ARTHRITIS: ANALYSIS OF A SUBGROUP OF PATIENT WITH LESS THAN THREE YEARS DISEASE DURATION.
OBJECTIVES: We explore the efficacy of etanercept with and without MTX in a homogeneous population of recently diagnosed RA patients.
CRA 2015-049-Does combining MTX to ETA improve it’s retention in early RA
8. COMPARING ABATACEPT TO ADALIMUMAB, ETANERCEPT AND INFLIXIMAB AS FIRST LINE AGENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS. EXPERIENCE FROM THE PROVINCIAL ELECTRONIC DATABASE AND REGISTRY RHUMADATA®.
OBJECTIVES: To assess if patients with rheumatoid arthritis (RA) treated with abatacept after failure of a first line agent (MTX-IR) have a different drug survival rate than patients similarly treated with adalimumab, etanercept or infliximab.
CRA 2015-050-Comparing ABA to ADA, ETA and INF as 1st or 2nd line agents in RA
9. PREDICTION OF NON-ADHERENCE IN PATIENTS WITH RHEUMATOID ARTHRITIS.
OBJECTIVES: The primary objective of this study is to evaluate the validity of a quebec french version of the CQR and of a short 5 questions survey, and assess there possible uses as adherence screening tool.
CRA 2015-217-Prediction of non-adherance in patients with RA
10. PREDICTORS OF CLINICAL RESPONSE TO BIOLOGICS IN RHEUMATOID ARTHRITIS: EXPERIENCE FROM CANADIAN CLINICS.
OBJECTIVES: The purpose of this study was to explore the predictors of clinical response in RA patients followed at Canadian clinics.
CRA 2015-226-Predictors of clinical response to biologics in RA
11. DENOSUMAB, WITH AND WITHOUT BIOLOGIC THERAPY AND THE RISK OF INFECTION IN PATIENTS WITH RHEUMATOID ARTHRITIS.
OBJECTIVES: To evaluate the risk of infection in patients with RA treated with denosumab alone or concomitantly with a biologic agent (BA).
CRA 2015-245-Denosumab, biologics and the risk of infection in patients with RA
2014 in review
The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.
Here’s an excerpt:
A San Francisco cable car holds 60 people. This blog was viewed about 980 times in 2014. If it were a cable car, it would take about 16 trips to carry that many people.
Résumés de recherche présentés au 27e congrès français de Rhumatologie – 2014
Liste des résumés de recherche presentés au 27e congrès français de Rhumatologie. Pour télécharger une copie PDF de l’affiche, cliquez sur le lien approprié.
1. Utilisation du Rituximab comparée aux agents anti-TNF en deuxième et troisième ligne chez des patients souffrant de polyarthrite rhumatoïde ayant échoués à un premier agent anti-TNF. Une analyse de la base de données RHUMADATA®
L’ordre d’utilisation des agents biologiques après avoir échoué un inhibiteur de TNF est toujours une question d’intérêt. Les résultats d’études de Phase III démontrent une efficacité comparable de tous les agents biologiques et peu d’études comparatives ont été publiées. Les registres offrent la possibilité d’observer l’efficacité de ces agents dans un cadre clinique.
Nous désirons évaluer si les patients atteints de polyarthrite rhumatoïde traités par rituximab après avoir échoué un premier ou un deuxième agent anti-TNF ont un taux de rétention du médicament différent de celui des patients prescrits un agent anti-TNF (adalimumab, étanercept ou infliximab) et de comparer les stratégies de traitement utilisant le RIT comme deuxième ou troisième agent biologique.
Utilisation du Rituximab comparée aux agents anti-TNF en deuxième et troisième ligne
2. Profil des patients traités avec le tocilizumab dans un centre de référence rhumatologique à Montréal, Canada
Le Tocilizumab (TCZ) par voie intraveineuse a été approuvé au Canada, début avril 2010, comme le 9e agent biologique pour le traitement de la polyarthrite rhumatoïde (PR) et fut rapidement adopté par les rhumatologues canadiens. Nous rapportons ici le profil des patients ayant commencé cette thérapie à l’Institut de rhumatologie de Montréal et inclus dans la base de données prospective RHUMADATA®.
3.Prédiction de la non-adhérence chez les patients atteints de la polyarthrite rhumatoïde
Chez les patients atteints de polyarthrite rhumatoïde, l’adhérence médicamenteuse est primordiale afin d’éviter la progression de la maladie. Malheureusement, l’adhérence à la médication dans cette population est faible, variant de 60 à 70%. Étant donné l’importance de cette problématique, une approche par dépistage de la non-adhérence devrait être privilégiée.
Très peu d’outils pour questionner l’adhérence sont disponibles, mais il existe le Compliance-Questionnaire-Rheumotology (CQR) qui est un questionnaire de 19 questions développé en 1999 par Klerk et al. et qui a été validé en anglais pour la population polyarthrite rhumatoïde.
Prédiction de la non-adhérence chez les patients atteints de la polyarthrite rhumatoïde
RHUMADATA posters presented at the 2014 ACR annual meeting
List of RHUMADATA abstracts presented at the 2014 ACR meeting held in Boston. To download a PDF copy of a poster simply click on the appropriate link.
1. PROFILES OF SWITCHES IN PATIENT WITH ANKYLOSING SPONDYLITIS: COMPARING ADALIMUMAB, ETANERCEPT, INFLIXIMAB, GOLIMUMAB AND CERTOLIZUMAB.
OBJECTIVES: The goal of this analysis is to explore the first 6, 12 and 18 month period after first exposure to an initial agent and assess the cycling incidence from different anti-TNF agents namely adalimumab (ADA), etanercept (ETA), infliximab (INF), golimumab (GOL) or certolizumab (CERTO) in AS patients.
2523 – Profiles of switches in patients with AS
2. COMPARING ABATACEPT TO ADALIMUMAB, ETANERCEPT AND INFLIXIMAB AS FIRST LINE AGENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS. EXPERIENCE FROM THE PROVINCIAL ELECTRONIC DATABASE AND REGISTRY RHUMADATA®.
OBJECTIVES: To assess if patients with rheumatoid arthritis (RA) treated with abatacept after failure of a first line agent (MTX-IR) have a different drug survival rate than patients similarly treated with adalimumab, etanercept or infliximab.
1511 – Comparing ABA to ADA, ETA and INF as 1st or 2nd line agents in RA
3. USE OF RITUXIMAB COMPARED TO ANTI-TNF AGENTS AS SECOND AND THIRD LINE THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS. A REPORT FROM THE RHUMADATA® CLINICAL DATABASE AND REGISTRY.
OBJECTIVES: To evaluate if patients with rheumatoid arthritis (RA) treated with rituximab (RIT) after failing a first or a second anti-TNF agents (TNF-IR) have a different drug retention rate than patients similarly prescribed anti-TNF agents (pooled adalimumab, etanercept or infliximab) and compare the treatment strategies of using RIT as second or third biologic treatment.
1510 – Use of rituximab as second line biologic agent
4. USE OF MONOTHERAPY ANTI-TNF AGENTS IN ANKYLOSING SPONDYLITIS PATIENTS FROM THE RHUMADATA® REGISTRY: 8-YEAR COMPARATIVE EFFECTIVENESS OF ADALIMUMAB, ETANERCEPT AND INFLIXIMAB.
OBJECTIVES: To assess the retention rates of adalimumab (ADA), etanercept (ETA) and infliximab (INF) in patients diagnosed with ankylosing spondylitis (AS) and to compare patient reported response over time.
0568 – Use of monotherapy anti-TNF agents in AS
5. DISEASE ACTIVITY SCORING: COMPARING PATIENT AND PHYSICIAN GLOBAL ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS STARTING A FIRST BIOLOGIC AGENT.
OBJECTIVES: We hypothesized that while absolute values of patient and physician global disease activity do not always correlate, changes in these measures may offer a better correlation. To this end, we looked at global evaluation changes before and after introduction of a first biologic agent in patient with RA.
0396 – Disease activity scoring-comparing patient to physician global
6. TOCILIZUMAB USE IN PATIENTS WITH RHEUMATOID ARTHRITIS HAVING FAILED ONE PREVIOUS ANTI-TNF AGENT: COMPARISON WITH ADALIMUMAB, ETANERCEPT AND INFLIXIMAB FROM THE PROVINCIAL ELECTRONIC DATABASE AND REGISTRY RHUMADATA®.
OBJECTIVES: The goal of this analysis is to describe the effectiveness of tocilizumab in patients with RA failing a first anti-TNF DMARDs and to compare its retention rate versus adalimumab, etanercept and infliximab in the same clinical situation.
0502 – Tocilizumab use in patients with rheumatoid arthritis
7. BIOLOGIC DISCONTINUATION IN RHEUMATOID ARTHRITIS: EXPERIENCE FROM CANADIAN CLINICS.
OBJECTIVES: To describe biologic treatment discontinuation and assess the predictors of discontinuation in RA patients followed at Canadian clinics.
0499 – Biologic discontinuation in RA- experience from a Canadian clinic
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Tocilizumab abstract 1-2014 ACR
Tocilizumab use in daily practice in patients with rheumatoid arthritis:
Description of the profile using the provincial electronic database and registry Rhumadata®
Author
Background/purpose: Tocilizumab, as an intra-venous biologic agent targeting IL-6, has been approved for rheumatoid arthritis (RA) in Canada in April 30th,2010. It was the sixth approved agent after adalimumab, etanercept, abatacept, infliximab and rituximab. It has been demonstrated effective in the treatment of RA either in monotherapy or combo therapy after non-biologic or biologic DMARDS [1, 2]. The goal of this analysis is to describe the clinical and therapeutic profiles of patients starting tocilizumab in the three Rhumadata® centers using the software.
Methods: All patients with RA exposed to tocilizumab were extracted from the Rhumadata® database. 6 cohorts were created according to the time tocilizumab was introduced: Initial monotherapy, traditional DMARDS-ir or subsequent TNF-ir from one to more than four. Demographics and baseline characteristics including age, gender, disease duration, Rheumatoid factor and anti-CCP antibodies, CRP and ESR, previous failed treatment number, DAS 28 ESR and CDAI, HAQ-DI were included for each cohorts.
Results: A total of 133 patients taking (n=82) or having taken tocilizumab in the past (n=51) were extracted for this analysis. Most subjects were women (84%) and the mean age at diagnosis was 58.8 (StD=12.9) years. Mean duration of disease from first symptoms was 15.3(StD=10.4) years. Most subjects were non-smokers (82%). Fifty-three (40%) were concomitantly treated with corticosteroids while on tocilizumab. As first biologic agent, DMARDS insufficient responders ( DMARDs-ir) tocilizumab was used in 33(25%) subjects. As second, third, fourth or more agent in biologic agent insufficient responders (Biologic IR) in respectively 34(26%), 27(20%) and 39(29%). Tocilizumab was used as monotherapy in 25(19%) patients. The remainder were concomitantly treated with a variety of commonly used traditional DMARDs. The most commonly used DMARDS were methotrexate (86/108=80%) and hydrochloroquine sulfate (45/108=42%). Most frequent past DMARDs used include hydrochloroquine sulfate (63/133=47%), methotrexate (39/133=29%), leflunomide (37/133=28%) and sulfasalazine (30/133=23%). Success to therapy with tocilizumab will be evaluated using survival analysis.
Conclusion: In community practice, where new agents for the treatment of any medical condition are oftently used as last resort strategy, efficacy outcomes could certainly yield biased perception. Registry, such as the provincial electronic database and registry Rhumadata®, where larger number of patients are pooled, can help decision making as to the optimal order of therapeutic options.
1. Bykerk, V.P., et al., Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice. Ann Rheum Dis, 2012. 71(12): p. 1950-4.
2. Emery, P., et al., IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis, 2008. 67(11): p. 1516-23.
ic agent
Use of Rituximab as second line biologic agent
Background: The order of use of biologic agents after failing a TNF inhibitor is still a question for debate. Phase III trial data in TNF-IR patients show comparable efficacy results across biologic agents and limited head-to-head studies have been published. Prospective registries offer a unique opportunity to observe the effectiveness (combined evaluation of efficacy and safety profile over time) of these agents in a clinical setting.
Objectives: To evaluate if patients with rheumatoid arthritis (RA) treated with rituximab after failing a first anti-TNF agents (TNF-IR) have a different drug retention rate than patients similarly prescribed adalimumab, etanercept or infliximab.
Methods: Data from TNF-IR RA patients prescribed adalimumab (ADA), etanercept (ETA), infliximab (INF) or rituximab (RIT) as a second biologic agent on or after January 1st 2007 was extracted. Baseline demographics included age, disease duration, HAQ-DI, fatigue and pain visual analog scale evaluations (VAS), TJC, SJC, DAS 28 ESR and SDAI. Person-years of treatment were also compared across biologic agents. Five-year drug retention rates were estimated and compared using Kaplan-Meier survival estimates. Statistical analysis was performed using SAS version 9.3. RHUMADATA® is a clinical database and registry used in daily clinical practice at the IRM and CORQ.
Results: The data from 126 RA patients were extracted. No significant differences in baseline variables were observed between treatment groups. The 5 year retention rates of ADA, ETA, INF and RIT after failing second line anti-TNF agent were 28%, 27%, 13% and 66% with significant statistical differences (Log-rank p<0.001).
Conclusions: As a second line agent, in TNF-IR patients, Rituximab demonstrate a better 5 year retention rate than the comparator agents.
Rhumadata 