title: Efficacy and prognostic factors of treatment retention with intravenous abatacept for rheumatoid arthritis: 24-month results from an international, prospective, real-world study.
abstract: OBJECTIVE
  To evaluate retention of abatacept over 24 months in patients with rheumatoid arthritis (RA) in routine clinical practice across Europe and Canada.
  
  
  METHODS
  ACTION (AbataCepT In rOutiNe clinical practice) was a prospective, observational, multicentre study of adult patients with moderate-to-severe RA who, at their physician's discretion, initiated treatment with intravenous abatacept. Enrolment occurred from May 2008 to December 2010, with up to 30 months of follow-up. The primary endpoint was the abatacept retention rate over 24 months. Crude abatacept retention rate was estimated using the Kaplan-Meier method. Prognostic factors of abatacept retention in patients with ≥1 prior biologic failure were derived from a Cox proportional hazards regression model, accounting for clustered data.
  
  
  RESULTS
  A total of 1137 patients were enrolled (1573 patient-years on abatacept); most (89.2%) had experienced prior biologic failure. The overall crude abatacept retention rate at 24 months was 54.4% (95% confidence interval: 51.3, 57.4). Positivity for both rheumatoid factor and anti-cyclic citrullinated antibody, previous exposure to one or no anti-tumour necrosis factor agents, and cardiovascular comorbidity were prognostic of higher abatacept retention. Erythrocyte sedimentation rate ≥51 mm/hour and introduction of corticosteroid use at abatacept initiation were predictors of lower abatacept retention. Abatacept retention varied according to country. Abatacept was well tolerated without any unexpected safety signals.
  
  
  CONCLUSIONS
  In a real-world setting, intravenous abatacept treatment retention was more than 50% at 24 months. The identification of prognostic factors of abatacept retention could support individualised biologic treatment strategies in patients with moderate-to-severe RA.
authors.affiliation: Rheumatologische Schwerpunktpraxis, University of Erlangen-Nuremberg, Germany. nuesslein.hu@googlemail.com.
authors.forename: Hubert G
authors.initials: HG
authors.lastname: Nüßlein
authors.affiliation: Schlosspark-Klinik University Medicine, Berlin, Germany.
authors.forename: Rieke
authors.initials: R
authors.lastname: Alten
authors.affiliation: University of Siena, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
authors.affiliation: University Hospital, Heidelberg, Germany.
authors.forename: Hanns-Martin
authors.initials: HM
authors.lastname: Lorenz
authors.affiliation: VU University Medical Center/Jan van Breeman Research Institute, Amsterdam, The Netherlands.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
authors.affiliation: St. Josephs Hospital and McMaster University, Hamilton, Canada.
authors.forename: William G
authors.initials: WG
authors.lastname: Bensen
authors.affiliation: Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Gerd R
authors.initials: GR
authors.lastname: Burmester
authors.affiliation: University of Freiburg, Germany.
authors.forename: Hans-Hartmut
authors.initials: HH
authors.lastname: Peter
authors.affiliation: Evangelisches Krankenhaus, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Peichl
authors.affiliation: Institute of Rheumatology, Prague, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Pavelka
authors.affiliation: Chiltern International, Neuilly, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Chartier
authors.affiliation: Docs International, Nanterre, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Poncet
authors.affiliation: Bristol-Myers Squibb, Munich, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Rauch
authors.affiliation: Bristol-Myers Squibb, Rueil-Malmaison, France.
authors.forename: Manuela
authors.initials: M
authors.lastname: Le Bars
mesh_terms: D000069594:Abatacept / Q000008:administration & dosage / Q000009:adverse effects; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy; D001799:Blood Sedimentation / Q000187:drug effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D011379:Prognosis; D012217:Rheumatoid Factor / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000069594:Abatacept; D012217:Rheumatoid Factor