title: Predictive factors for achieving low disease activity at 52 weeks after switching from tumor necrosis factor inhibitors to abatacept: results from a multicenter observational cohort study of Japanese patients.
abstract: This study aimed to identify predictive factors for achieving low disease activity (LDA) in rheumatoid arthritis (RA) patients switching from tumor necrosis factor inhibitors (TNFis) to abatacept (ABT). Patients who were registered in the multicenter observational Tsurumai Biologics Communication Registry (TBCR) were enrolled in this study. Predictive factors for LDA achievement at each time point were determined by univariate and multivariate logistic regression analyses. The cutoffs of 28-point count Disease Activity Score (DAS28)-C-reactive protein (CRP) and ΔDAS28-CRP from baseline up to 24 weeks for LDA achievement at 52 weeks were explored using receiver operating characteristic (ROC) curves. Of 2771 RA patients registered until 2013, 76 with moderate or high disease activity were selected. Twenty-six percent of the patients achieved LDA. Multivariate analysis confirmed that DAS28-CRP at 12 weeks and ΔDAS28-CRP from baseline to 12 weeks were independent factors for LDA achievement at 52 weeks [odds ratio (OR) 0.26, 95% confident interval (CI) (0.12-0.56), OR 0.25, 95% CI (0.11-0.57), respectively]. The best cutoff values of DAS28-CRP at 12 weeks and ΔDAS28-CRP from baseline to 12 weeks for LDA at 52 weeks were 3.9 (sensitivity 0.85, specificity 0.78) and -0.97 (sensitivity 0.70, specificity 0.70), respectively. Seventy-one percent of patients who achieved both of these cutoff values at 12 weeks achieved LDA at 52 weeks. Our findings suggest that the clinical course up to 12 weeks is important for predicting long-term outcomes when switching from TNFis to ABT.
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. toshik@med.nagoya-u.ac.jp.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Nobunori
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya Medical Center, 4-1-1 Sanno-maru, Naka-ku, Nagoya, Aichi, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kaneko
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya Medical Center, 4-1-1 Sanno-maru, Naka-ku, Nagoya, Aichi, Japan.
authors.forename: Daihei
authors.initials: D
authors.lastname: Kida
authors.affiliation: Department of Rheumatology, Toyohashi Municipal Hospital, 50 Hakken-nishi, Aotake-cho, Toyohashi, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirano
authors.affiliation: Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Oomatsubara, Takaya-cho, Konan, Aichi, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Fujibayashi
authors.affiliation: Department of Rheumatology, JCHO Tokyo-Shinjyuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yabe
authors.affiliation: Department of Orthopedic Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihirokute, Anjo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oguchi
authors.affiliation: Department of Orthopedic Surgery, Ichinomiya Municipal Hospital, 2-2-22, Bunkyo, Ichinomiya, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Kato Orthopedic Clinic, 8-4 Minami-myoudaiji-cho, Okazaki, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Orthopedic Surgery, Kariya-Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Rheumatology, Nagano Red Cross Hospital, 5-22-1 Wakazato, Nagano, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Orthopedic Surgery, Shizuoka Kosei Hospital, 23 Kitaban-cho, Aoi-ku, Shizuoka, Japan.
authors.forename: Tomone
authors.initials: T
authors.lastname: Shioura
authors.affiliation: Department of Orthopedic Surgery, Toyota Kosei Hospital, 500-1 Ibohara, Josui-cho, Toyota, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Kanayama
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Funahashi
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Asai
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yoshioka
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Terabe
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Toki
authors.initials: T
authors.lastname: Takemoto
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Asai
authors.affiliation: Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000069594:Abatacept / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D044466:Asian People; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012372:ROC Curve; D012042:Registries; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000069594:Abatacept; D002097:C-Reactive Protein; D008727:Methotrexate
keywords: Abatacept; Biologics; Predictive factors; Rheumatoid arthritis; Tumor necrosis factor inhibitor