ABATACEPT SHOWS BETTER SUSTAINABILITY THAN TNF INHIBITORS WHEN USED FOLLOWING INITIAL BIOLOGIC DMARD FAILURE IN THE TREATMENT OF RHEUMATOID ARTHRITIS: 8 YEARS OF REAL-WORLD OBSERVATIONS FROM THE RHUMADATA® CLINICAL DATABASE AND REGISTRY

Background: In the absence of biomarkers predicting response to a specific therapy, the choice of second biologic is based mostly on habit and availability of an alternative agent. Traditionally, a second anti-TNF was the preferred option, but recent registry data point to better responses and retention if a drug with a different mode of action is prescribed. Objectives: Assess the long-term retention of abatacept (ABA) and TNFi following first biologic (b)DMARD inadequate response in RHUMADATA® registry patients (pts) with RA. Methods: Data from RHUMADATA® pts with RA prescribed either ABA or TNFi as the second bDMARD after 1 January 2006 were analysed. Pts were followed until treatment discontinuation or 9 January 2017 cut-off. Pt characteristics were compared using descriptive statistics, bDMARD discontinuation rates using Kaplan-Meier methods, and proportional hazard models were used to identify predictors of treatment discontinuation. Results: Data for 92 and 194 pts prescribed ABA or a TNFi, respectively, as second-line treatment were extracted. No clinically significant differences in baseline characteristics were noted between treatment groups. Most pts were women (76.2%), average age (SD) was 45.1 (13.3) years at diagnosis and disease duration 10.8 (9.0) years. Most pts were stopping an anti-TNF agent: 97% of those who were switched to ABA and 83% of those who were prescribed a second anti-TNF. Overall, 77.6% of pts stopped their first bDMARD after >6 months of treatment (secondary failure). Significant differences in retention between ABA and TNFi groups (log-rank p=0.0002) were observed (Table, Figure). Results remained unchanged for pts treated with TNFi only in first line, and primary/secondary failure of the first bDMARD did not affect sustainability of the second agent. Lack of efficacy (57.7%) and AEs (16.5%) were the most commonly cited reasons for treatment discontinuation. Table 1. First bDMARD failure and retention characteristics of the second bDMARD Second bDMARD TNFiAbatacept First bDMARD FailedFailure typeAllFailure typeAll PrimarySecondaryPrimarySecondary TNF inhibitor, n, %41, 25.5%120, 74.5%161, 100%17, 19.1%72, 80.9%89, 100% Other mode of action6, 18.2%27, 81.8%33, 100%0, 0%3, 100%3, 100% Total47, 24.2%147, 75.8%194, 100%17, 18.5%75, 81.5%92, 100% Second bDMARD Retention Probability at:  6 Months64.68% (3.45%)83.51% (3.89%)  12 Months50.54% (3.61%)76.73% (4.45%)  24 Months39.77% (3.59%)59.97% (5.29%)  60 Months22.26% (3.53%)36.95% (6.17%)  96 Months13.22% (3.62%)30.66% (6.61%) Biologic Retention Time (years)  Mean, mean (SE)2.71 (0.25)3.33 (0.26)  Lower Quartile (95% CI)0.36 (0.28–0.44)1.02 (0.49–1.29)  Median (95% CI)1.08 (0.71–1.60)3.17 (1.92–4.78)  Upper Quartile (95% CI)4.26 (3.25–6.64)++ (5.24-++) % survival (standard error of % survival). Conclusions: Abatacept has better sustainability over a second line TNFi in RA patients having failed one prior bDMARD. Disclosure of Interest: D. Choquette Consultant for: BMS, Speakers bureau: BMS, L. Bessette Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant for: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Celgene, Lilly, Novartis, E. Alemao Shareholder of: BMS, Employee of: BMS, B. Haraoui Grant/research support from: BMS, Janssen, Roche, Consultant for: Abbvie, Amgen, BMS, Celgene, Janssen, Merck, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Pfizer, UCB, F. Massicotte: None declared, M. Mtibaa Shareholder of: BMS, Employee of: BMS, E. Muratti Employee of: BMS, J.-P. Pelletier: None declared, R. Postema Shareholder of: BMS, Employee of: BMS, J.-P. Raynauld Speakers bureau: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, Sanofi, Novartis, UCB, M.-A. Rémillard: None declared, D. Sauvageau: None declared, A. Turcotte Consultant for: Amgen, Abbvie, BMS, Celegene, Janssen, Roche, Pfizer, Lilly, Novartis, Merck, Sanofi, UCB, Speakers bureau: Amgen, Abbvie, BMS, Celegene, Janssen, Roche, Pfizer, Lilly, Novartis, Merck, Έ. Villeneuve Speakers bureau: Abbvie, Roche, BMS Consultant - Celgene, Cimzia, Pfizer, L. Coupal: None declared DOI: 10.1136/annrheumdis-2017-eular.2379Citation: Annals of the Rheumatic Diseases, volume 76, supplement 2, year 2017, page 1188Session: Rheumatoid arthritis - other biologic treatment (Abstracts Accepted for Publication )