Efficacy, Safety of Biologics Assessed in Relapsing Polychondritis

A retrospective cohort study published in the Annals of Rheumatic Disease found differences in the efficacies and safety profiles of biologics for the treatment of relapsing polychondritis and showed that, in general, biologics have a low rate of complete response in this patient population.

The cohort was established from multiple medical centers in France and included adult patients treated with biologics for relapsing polychondritis between 2001 and July 2015. Inclusion criteria were an age of ≥18 years and relapsing polychondritis satisfying the McAdam, Damiani and Levine, and Michet diagnosis criteria. The exclusion criterion was patient opposition to data collection.

Forty-one patients, 53.6% of whom were women, with a mean age of 46.9 years, were included from 14 centers. In total, 105 exposures to biologics were recorded. The median time from diagnosis to first-line initiation was 26.5 months; nasal chondritis, arthralgia, and auricular chondritis were the most frequent involvements. All but 2 patients had an active disease at the time of initiation, and all but 3 had previous exposure to nonbiologic disease-modifying antirheumatic drugs. The reasons for initiating a biologic were corticosteroid dependence (n=28), an inadequate response to corticosteroids as judged by the prescriber (n=11), and adverse drug reactions to methotrexate (n=3).

Response rates and complete response rates during the first 6 months were 62.9% and 19.0%, respectively. Response rates were the lowest for abatacept (50.0%) and anakinra (53.3%). The response rate was 63.3% for tumor necrosis factor (TNF) inhibitors, 70.6% for tocilizumab, and 71.4% for rituximab. The investigators noted that 20.9% of biologics were withdrawn because of adverse drug reactions. The most frequent adverse drug reactions were infections (n=42) and reactions at the site of injecting subcutaneous biologics (n=12).

Although biologics showed a general response rate of 62.9%, the complete response rate was low at only 19.0%. While the study was retrospective and could not account for patient- or physician-influenced treatment choice, the baseline patient characteristics were similar between biologics. In addition, although the study confirmed a low rate of withdrawal because of adverse drug reactions for tumor necrosis factor inhibitors, the authors noted a high rate of discontinuation as a result of the low efficacy of etanercept. The authors suggested that further study should focus on head-to-head comparisons of different biologics in the treatment of relapsing polychondritis.

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Reference

Moulis G, Pugnet G, Costedoat-Chalumeau N, et al. Efficacy and safety of biologics in relapsing polychondritis: a French national multicentre study [published online April 6, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2017-212705