Background: Even after the advent of multiple biologic drugs, optimum treatment of rheumatoid arthritis (RA) in a real-world situation continues to be challenging. The data on long-term drug survival of biologic drugs in routine clinical practice is lacking. We extended our earlier analysis of abatacept use in RA patients ^1,2 from a single centre in the United Kingdom over 7 years.

Objectives: To assess the efficacy, tolerability and drug survival of abatacept use in RA patients in a routine clinical setting like ours.

Methods: From November 2010 to December 2017, all RA patients with at least 6 months of follow up after abatacept initiation were included in the analysis. Data on demographics, disease duration, previous biologics, mode of administration, reasons for discontinuation and length of abatacept therapy were retrospectively collected from biologics database and medical records. Effectiveness was assessed by change in Disease activity scores (DAS 28) and European League Against Rheumatism response criteria (EULAR) after 6 months of therapy.

Results: 220 patients had received abatacept with at least 6 months follow up until December 2017. 176 were females and 44 males with mean age of 67.83 years (SD =10.32). Mean disease duration in these patients was 14.42 years (SD = 8.11). 152 (69%) patients were seropositive (Rheumatoid factor and/or anti-CCP antibody). 207 (94%) patients had received a prior biologic and only 13 (6%) patients were biologic naïve. 193 (87.7%) patients were initiated on intravenous (iv) abatacept and 27 (12.2%) patients on subcutaneous (s/c) abatacept. 90 (40.9%) patients were successfully switched from iv to s/c abatacept.

The mean number of prior biologic drugs use per patient was 1.70 (SD = 1.03). 83.6 % patients were co-prescribed DMARDs at the initiation of abatacept therapy. Mean baseline DAS 28 score was 6.02 (SD = 3.11). Average DAS 28 change at 6 months was -1.5 (95 % CI -1.27, -1.33). 75 % patients had a positive EULAR response (38% good, 37% moderate) and 25% had no response at 6 months.

Overall 57 (25.9 %) patients discontinued treatment. 43 (19.5%) patients discontinued abatacept early (<9 months) due to primary inefficacy (10.9 %) and adverse reactions (8.6%). 24 (10.9%) patients discontinued abatacept later, after a mean 27.46 (SD = 12.9) months of use, due to secondary loss of efficacy (6.3%) and adverse reactions (4.5%).

82 % (180/220) of RA patients continued taking abatacept beyond 6 months. 61.5% (91/148) patients were still adherent at 2 years, 51.3% (39/76) retained the drug beyond 48 months.

Conclusions: Abatacept continues to be a safe and effective treatment option for patients with RA who are biologic naïve or after discontinuation of prior biologic due to failure or intolerance. A significant number of patients continue on abatacept even after 4 years.

References:

1. Joshi P, Sheeran T, Venkatachalam S, et al. AB0370 Real Life Experience with Abatacept in Patients with Rheumatoid Arthritis from A Regional Centre in UK. Annals of the Rheumatic Diseases 2016;75:1030.
2. Ahmed N, Roskell S, Passey K, et al. AB0441 Abatacept in Rheumatoid Arthritis (RA) Patients: Real-Life Experience in A Subregional Centre in Uk. Annals of the Rheumatic Diseases 2014;73:954.

Acknowledgements: We would like to thank the whole team and patients at The Rheumatology Centre of The Royal Wolverhampton trust.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.5716