Persistence Rates of Abatacept vs Tumor Necrosis Factor Inhibitors in RA

Illustration showing the structure of an antibody, or immunoglobulin, molecule. These Y-shaped molecules have two arms that can bind to specific antigens, for instance viral or bacterial proteins. In doing so, they mark the antigen for destruction.
Using a Canadian registry of patients with rheumatoid arthritis, researchers found data that showed therapy with abatacept was consistent and remained so for a longer duration.

For patients with rheumatoid arthritis, abatacept and tumor necrosis factor inhibitors (TNFis) have persistence rates that are similar to those of first-line biologic treatment, but abatacept is superior as a second-line biologic treatment, according to results published in Arthritis Research and Therapy.

The study included participants with RA from the Rhumadata® registry who were prescribed either abatacept or a TNFi (adalimumab, certolizumab, etanercept, golimumab, or infliximab). The primary outcome was adherence with abatacept and TNFi treatment, and secondary outcomes included the proportion of patients discontinuing therapy, reasons for discontinuation, and predictors of discontinuation.

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The researchers defined adherence as the time from initiation to discontinuation of biologic therapy. They used Kaplan-Meier methods to estimate cumulative persistence rates, which were compared using the log-rank test.

Of 705 participants, 92 were prescribed abatacept and 613 were prescribed a TNFi. Of all participants, 317 met the criteria for second-line biologic agent initiation (105 for abatacept, 212 for TNFi). The researchers did not note any clinically significant differences in baseline characteristics between treatments with first- or second-line biologics.

The results indicated that persistence was similar between the first-line biologic treatments (P =.7406). However, as a second-line biologic, abatacept had significantly higher adherence compared with TNFi (P =.0001).

As a first-line biologic, the mean (standard deviation) time for abatacept was 4.53 (0.41) years compared with 5.35 (0.20) years for TNFi. As a second-line biologic, the mean times were 4.80 (0.45) and 2.82 (0.24) years, respectively.

With first-line biologics, 51.1% of those taking abatacept discontinued treatment compared with 59.5% of those taking a TNFi (P =.1404). With second-line biologics, those rates were 57.1% and 74.1%, respectively (P =.0031). The most common reasons for discontinuation of treatment were inefficacy and adverse events.

“The results from the unselected population in this study support the clinical trial data and are more generalizable to patients found in clinical practice,” the researchers wrote.


Choquette D, Bessette L, Alemao E, et al. Persistence rates of abatacept and TNF inhibitors used as first or second biologic DMARDs in the treatment of rheumatoid arthritis: 9 years of experience from the Rhumadata® clinical database and registry. Arthritis Res Ther. 2019;21:138.