Golimumab Retention Rates Lower in Patients With RA vs Other Rheumatic Diseases

Among patients with rheumatic diseases who discontinued treatment with non-tumor necrosis factor (TNF) inhibitors, approximately one-third continued to use golimumab as a third or subsequent line of therapy after 4 years, according to results of a retrospective analysis published in Advances in Rheumatology.

There is evidence that using biological disease-modifying antirheumatic drugs(bDMARD) or targeted synthetic disease-modifying antirheumatic drugs (tsDMARD) such as TNF inhibitors are effective treatments for patients with rheumatic diseases. However, there are limited data on whether use of TNF inhibitors remains effective after discontinuation of non-TNF inhibitors.

Researchers assessed golimumab treatment retention over a 4-year period in patients with rheumatic diseases who previously stopped taking non-TNF inhibitors. The analysis included adults with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA). Patient data were captured from February 2000 to December 2021 from the Spanish registry of biological drugs.

Secondary outcomes included retention rates based on specific disease diagnoses and lines of therapy. Retention rates were calculated using Kaplan-Meier survival analysis.

A total of 125 patients with RA (n=72), axSpA (n=23), or PsA (n=30) were included in the study. Overall, golimumab was initiated as second-line therapy in 26 patients (20.8%), third-line therapy in 29 (23.2%), and as a fourth or subsequent line of therapy in 70 (56.0%). The median disease duration was 10 years, and 68.0% of patients were women. 

Commonly discontinued treatments among patients with RA included abatacept, tocilizumab, tofacitinib, and baricitinib. In patients with PsA, commonly discontinued treatments included secukinumab, ustekinumab, and apremilast. All but 2 discontinuations among patients with axSpA were attributed to secukinumab.

Overall, approximately one-third of patients were receiving golimumab treatment at 4 years.

The retention rates for golimumab decreased over time, with 60.7% (95% CI, 51.4-68.8) of patients still using it after 1 year, 45.9% (95% CI, 36.0-55.2) after 2 years, 39.9% (95% CI, 29.8-49.7) after 3 years, and 33.4% (95% CI, 23.0-44.2) after 4 years. The retention rates were not significantly different depending on whether golimumab was used as a second, third, or fourth/subsequent line of therapy (P =.462).

Golimumab retention rates were found to be higher among patients with axSpA or PsA than those with RA (P =.002). When golimumab was given as a third or fourth/subsequent line of therapy after discontinuation of non-TNF inhibitors, 4-year retention rates were similar to those observed after discontinuation of TNF inhibitors.

Cox regression models revealed women were more likely to discontinue golimumab therapy, as well as initiate it as a fourth/subsequent vs secondary line of therapy.

This study is limited by its retrospective, noncomparative, observational design, as well as the predominance patients with RA. Further, the majority of patients received golimumab as a fourth/subsequent line of therapy.

The researchers concluded, “Given the wide range of therapies now available for the treatment of patients with rheumatic diseases, there will be an increasing number of patients who need to switch from non-TNF [inhibitors] bDMARDs and tsDMARDs to alternative treatments.”