title: Comparative effectiveness of abatacept versus tocilizumab in rheumatoid arthritis patients with prior TNFi exposure in the US Corrona registry.
abstract: We compared the effectiveness of abatacept (ABA) vs tocilizumab (TCA) in tumor necrosis factor inhibitor (TNFi) experienced patients.
  
  
  
  We identified rheumatoid arthritis (RA) patients from a large observational US cohort (1 January 2010-31 May 2014) who had discontinued at least one TNFi and initiated ABA or TCZ in moderate or high disease activity based on the Clinical Disease Activity Index (CDAI) and had no prior exposure to the comparator drug. Using propensity score matching (1:1) stratified by prior TNF use (1 TNFi vs ≥2 TNFis), effectiveness at 6 months after initiation was evaluated. Mean change in CDAI over 6 months following initiation was the primary outcome, with secondary outcomes of achievement of low disease activity/remission (CDAI ≤ 10) and mean change in modified Health Assessment Questionnaire (mHAQ) score.
  
  
  
  The 264 pairs of propensity score-matched ABA and TCZ initiators were well matched with no substantial differences in the baseline characteristics, defined as standardized differences >0.1 in the stratification. Both treatment groups had similar mean change in CDAI at 6 months (-11.3 in ABA vs -9.9 in TCZ; mean difference -1.27, 95% CI -3.65, 1.11). Similar proportions of both treatment groups achieved low disease activity/remission (adjusted odds ratio for ABA vs TCZ 0.99, 95% CI 0.69, 1.43). Mean change in mHAQ was -0.12 in ABA initiators vs -0.11 in TCZ initiations (mean difference -0.01, 95% CI -0.09, 0.06).
  
  
  
  Patients receiving either ABA or TCZ had substantial improvement in clinical disease activity. In this propensity score-matched sample, similar outcomes were observed for both treatment cohorts.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, AC7-201, Worcester, MA, 01655, USA. Leslie.Harrold@umassmed.edu.
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Harrold
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, AC7-201, Worcester, MA, 01655, USA.|Corrona, LLC, Southborough, MA, USA.
authors.forename: George W
authors.initials: GW
authors.lastname: Reed
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: Corrona, LLC, Southborough, MA, USA.
authors.forename: Mei
authors.initials: M
authors.lastname: Liu
authors.affiliation: Corrona, LLC, Southborough, MA, USA.|NYU School of Medicine, New York, NY, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
authors.affiliation: Albany Medical College, Albany, NY, USA.|The Center for Rheumatology, Albany, NY, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Kremer
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069594:Abatacept; C502936:tocilizumab
keywords: Abatacept; Disease-modifying anti-rheumatic drugs (biologic); Rheumatoid arthritis; Tocilizumab; Treatment