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The impact of seropositivity on the effectiveness of biologic anti-rheumatic agents: results from a collaboration of 16 registries

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Rheumatology (Oxford). 2020 Aug 18;keaa393. doi: 10.1093/rheumatology/keaa393.Online ahead of print.

Delphine S Courvoisier 1, Katarina Chatzidionysiou 2, Denis Mongin 1, Kim Lauper 1 3, Xavier Mariette 4, Jacques Morel 5, Jacques-Eric Gottenberg 6, Sytske Anne Bergstra 7, Manuel Pombo Suarez 8, Catalin Codreanu 9, Tore K Kvien 10, Maria Jose Santos 11, Karel Pavelka 12, Merete L Hetland 13 14, Johan Askling 15, Carl Turesson 16, Satoshi Kubo 17, Yoshiya Tanaka 17, Florenzo Iannone 18, Denis Choquette 19, Dan C Nordström 20, Ziga Rotar 21, Galina Lukina 22, Cem Gabay 1, Ronald Van Vollenhoven 22, Axel Finckh 1

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Abstract

Objectives: RF and ACPA are used as diagnostic tools and their presence has been associated with clinical response to some biologic DMARDs (bDMARDs) in RA. This study compared the impact of seropositivity on drug discontinuation and effectiveness of bDMARDs in patients with RA, using head-to-head comparisons in a real-world setting.

Methods: We conducted a pooled analysis of 16 observational RA registries. Inclusion criteria were a diagnosis of RA, initiation of treatment with rituximab (RTX), abatacept (ABA), tocilizumab (TCZ) or TNF inhibitors (TNFis) and available information on RF and/or ACPA status. Drug discontinuation was analysed using Cox regression, including drug, seropositivity, their interaction, adjusting for concomitant and past treatments and patient and disease characteristics and accounting for country and calendar year of bDMARD initiation. Effectiveness was analysed using the Clinical Disease Activity Index evolution over time.

Results: Among the 27 583 eligible patients, the association of seropositivity with drug discontinuation differed across bDMARDs (P for interaction <0.001). The adjusted hazard ratios for seropositive compared with seronegative patients were 1.01 (95% CI 0.95, 1.07) for TNFis, 0.89 (0.78, 1.02)] for TCZ, 0.80 (0.72, 0.88) for ABA and 0.70 (0.59, 0.84) for RTX. Adjusted differences in remission and low disease activity rates between seropositive and seronegative patients followed the same pattern, with no difference in TNFis, a small difference in TCZ, a larger difference in ABA and the largest difference in RTX (Lundex remission difference +5.9%, low disease activity difference +11.6%).

Conclusion: Seropositivity was associated with increased effectiveness of non-TNFi bDMARDs, especially RTX and ABA, but not TNFis.