title: Comparative efficacy of tocilizumab, abatacept and rituximab after non-TNF inhibitor failure: results from a multicentre study.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy of tocilizumab, rituximab and abatacept after a non-tumor necrosis factor inhibitor (non-TNFi) failure for the treatment of rheumatoid arthritis (RA).
  
  
  METHODS
  This retrospective multi-centre study included patients treated for RA with abatacept, rituximab or tocilizumab after having received in the previous line the first non-TNFi. Data were collected from patient charts. The primary endpoint was the delta Disease Activity Index of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) and DAS28-CRP (C-reactive protein) at 12 months. The relative change in primary outcome measures from baseline were calculated.
  
  
  RESULTS
  One hundred patients started a second non-TNFi between 2006 and 2013, including 15 patients treated with rituximab, 36 with tocilizumab and 49 with abatacept. The change of DAS28-ESR was significantly different between the three groups (P = 0.001). In post hoc pairwise comparisons, patients treated with tocilizumab had a higher decrease of the DAS28-ESR than patients treated by abatacept (median [interquartile range: IQR]: 36% [0; 54%] vs. 0% [0; 20%], P = 0.002). A similar non-significant difference was found between tocilizumab and rituximab (median [IQR] decrease: 36% [0; 54%] vs. 0% [-11; 34%], P = 0.07). Similar results were found with the 12 months change in DAS28-CRP.
  
  
  CONCLUSIONS
  This study suggests a better efficacy of tocilizumab compared with abatacept and rituximab in situations of non-TNFi failure.
authors.affiliation: Department of Rheumatology, Saint-Philibert Hospital, Lille University, Lomme, France.|Department of Rheumatology, CHU Lille, Lille, France.|EA 4490, University-Hospital of Lille, CHU Lille, Lille, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Pascart
authors.affiliation: Department of Rheumatology, CHU Lille, Lille, France.
authors.forename: Peggy
authors.initials: P
authors.lastname: Philippe
authors.affiliation: Department of Biostatistics, Univ. Lille, CHU Lille, Lille, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Drumez
authors.affiliation: Department of Rheumatology, Valenciennes Hospital, Valenciennes, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Deprez
authors.affiliation: Department of Rheumatology, CHU Lille, Lille, France.|EA 4490, University-Hospital of Lille, CHU Lille, Lille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cortet
authors.affiliation: Department of Biostatistics, Univ. Lille, CHU Lille, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Department of Rheumatology, Saint-Philibert Hospital, Lille University, Lomme, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Houvenagel
authors.affiliation: Department of Rheumatology, CHU Lille, Lille, France.
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
mesh_terms: D000069594:Abatacept / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D057915:Drug Substitution; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D015415:Biomarkers; D000069283:Rituximab; D000069594:Abatacept; D002097:C-Reactive Protein; C502936:tocilizumab
keywords: abatacept; biologics failure; rheumatoid arthritis; rituximab; tocilizumab