title: The durability of abatacept as a first and subsequent biologic and improvement in HAQ from a large multi-site real-world study.
abstract: OBJECTIVE
  Assessment of the effectiveness of newer biologics such as abatacept is essential in real-world practice.
  
  
  METHODS
  RA patients administered infusions of abatacept via the Orencia Response Program network with at least one follow-up evaluation were included. The number needed to treat (NNT) to improve HAQ by at least the minimal clinically important difference (MID ≥ 0.22) and abatacept survival and differences between biologic-naïve and TNFi-experienced patients were assessed.
  
  
  RESULTS
  Among 2929 patients enrolled, 1771 (60.5%) were eligible for analysis (mean age was 57.6 years, disease duration was 16.5 ± 11.0 (SD) years, 77.2% were female, and 79.2% had past TNFi), with mean follow-up of 13.8 ± 12.3 (SD) months. Half had comorbidities including hypertension (17%), diabetes (8.4%), asthma (6.0%), hypothyroidism (5.7%), and hyperlipidemia (4.0%). Mean (SE) durability of treatment was 26.8 (0.53) months, where 66% were receiving abatacept at 12 months and 53% at 24 months. Patient survival was longer where abatacept was the first biologic vs. post-TNFi (P = 0.0001). In the use of abatacept as a first biologic, 70% achieved MID in HAQ vs. 71% if post-TNFi (P = 0.65) with NNT to improve one patient with at least MID of HAQ was 1.4.
  
  
  CONCLUSIONS
  Abatacept is effective in improving HAQ in RA both pre and post first biologic in real-world patients with comorbidities. For those still on abatacept, HAQ continued to improve over the first 2 years. The durability of abatacept is better as a first biologic, but NNT to improve HAQ patients on treatment is the same post-DMARDs and post-TNFi. For treatment durability and HAQ MID achievement, abatacept use as a first biologic is better.
authors.affiliation: Division of Rheumatology, Department of Medicine, St Joseph׳s Health Care, University of Western Ontario, 268 Grosvenor St, London, Ontario, Canada N6A 4V2. Electronic address: janet.pope@sjhc.london.on.ca.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: Department of Surgical Epidemiology, JSS Research, St Laurent, Quebec, Canada.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Rampakakis
authors.affiliation: Department of Surgical Epidemiology, JSS Research, St Laurent, Quebec, Canada; Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Sampalis
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D000069594:Abatacept
keywords: Abatacept; Cohort; Comorbidities; Database; Durability; First biologic; Function; HAQ; Health Assessment Questionnaire disability index; Number needed to treat (NNT); Post-TNFi; Real-world practice; Rheumatoid arthritis (RA)