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Concomitant methotrexate has little effect on clinical outcomes of abatacept in rheumatoid arthritis: a propensity score matching analysis

  • Nobunori TakahashiEmail author
  • Toshihisa Kojima
  • Daihei Kida
  • Atsushi Kaneko
  • Yuji Hirano
  • Takayoshi Fujibayashi
  • Yuichiro Yabe
  • Hideki Takagi
  • Takeshi Oguchi
  • Masahiro Hanabayashi
  • Takefumi Kato
  • Koji Funahashi
  • Masatoshi Hayashi
  • Seiji Tsuboi
  • Yasuhide Kanayama
  • Yasumori Sobue
  • Nobuyuki Asai
  • Takuya Matsumoto
  • Tatsuo Watanabe
  • Shuji Asai
  • Naoki Ishiguro
Original Article
  • 13 Downloads

Abstract

Objective

To compare the clinical outcomes of abatacept between rheumatoid arthritis patients with and without concomitant methotrexate (MTX) treatment in daily clinical practice.

Methods

A retrospective cohort study was performed using data from a multicentre registry. A total of 176 consecutive rheumatoid arthritis patients treated with abatacept were included. The propensity score based on multiple baseline characteristic variables was calculated, and 41 of 86 patients treated without MTX (MTX(−)) and 41 of 90 patients treated with concomitant MTX (MTX(+)) were statistically extracted and analysed. Clinical outcomes were evaluated and compared between the two groups over a 52-week period.

Results

Baseline characteristics were statistically comparable. No significant differences were observed in the following clinical outcomes from baseline throughout the 52-week period: drug retention rate (MTX(−)/MTX(+) 79.1%/80.5%), mean change in disease activity score based on 28 joints (DAS28-CRP) from baseline (− 1.35/− 1.54), low disease activity rate (48.8%/43.9%), clinical remission rate (31.7%/36.6%), moderate European League Against Rheumatism (EULAR) response rate (68.3%/68.3%), and good EULAR response rate (36.6%/41.1%) at 52 weeks.

Conclusion

In rheumatoid arthritis patients with similar background characteristics undergoing abatacept treatment, concomitant MTX does not seem to affect clinical outcomes. Abatacept would be a suitable treatment option in daily clinical practice in patients with contraindications to MTX.

Key Points

• This is the first study to directly compare the clinical efficacy and safety of abatacept between patients with and without concomitant methotrexate (MTX) treatment in ‘real-world’ settings using the propensity score matching method.

• There were no significant differences in clinical outcomes of abatacept between patients with and without concomitant MTX treatment.

• We used data from a large Japanese multicentre registry for biologics in rheumatoid arthritis, thereby decreasing selection bias based on the personal preferences of physicians.

Keywords

Abatacept Biological DMARDs Concomitant drug Methotrexate Multicentre registry Propensity score matching Rheumatoid arthritis 

Notes

Acknowledgements

We thank Dr. Toshihisa Kanamono (Department of Orthopedic Surgery, Nagano Red Cross Hospital, Nagano, Japan), Dr. Yukiyoshi Oh-ishi (Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Japan), Dr. Naoki Fukaya (Department of Orthopedic Surgery, Kariya–Toyota General Hospital, Kariya, Japan), and Dr. Seiji Tsuboi (Department of Orthopedic Surgery, Shizuoka Kosei Hospital, Shizuoka, Japan) for their helpful suggestions.

Compliance with ethical standards

This study was approved by the Ethics Committee of Nagoya University Graduate School of Medicine. Written informed consent was obtained from all participants.

Conflict of interest

N.I. received grants, lecture fees, and fees for serving on speakers’ bureaus from Daiichi Sankyo, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Taisho Toyama Pharmaceutical, Kaken Pharmaceutical, Eisai, Janssen Pharmaceutical, Bristol-Myers Squibb, Abbott Japan, Chugai Pharmaceutical, Mitsubishi Tanabe Pharmaceutical, Astellas Pharma, and Pfizer Japan. T.K. received lecture fees (< US$5000) from Mitsubishi Tanabe Pharma, Takeda Pharma, Eisai Pharma, AbbVie, Bristol-Myers Squibb, and Pfizer and $10,000 from Chugai Pharma. N.T. received speaker’s fees from Abbott Japan, Eisai, Mitsubishi Tanabe Pharma, Pfizer, Chugai Pharmaceutical, and Bristol-Myers Squibb (< $5000). Y.H. received speaker’s fees from Abbott Japan, Eisai, Mitsubishi Tanabe Pharma, Pfizer, Chugai Pharmaceutical, and Bristol-Myers Squibb (< $5000). A.K. received lecture fees (< $5000) from Mitsubishi Tanabe Pharma, Takeda Pharma, Eisai Pharma, Chugai Pharma, Abbott, Bristol-Myers Squibb, UCB, Janssen, and Pfizer. All other authors have no conflict of interest to report.

Supplementary material

10067_2019_4581_Fig5_ESM.png (140 kb)
Figure S1

Comparison of disease activity of patients with and without concomitant methotrexate (MTX) treatment. (A) Mean and standard deviation (SD) for Disease Activity Score based on 28 joints (DAS28-CRP). (B) Categorical distribution of DAS28-CRP in patients with and without concomitant MTX treatment. Disease activity was categorized as follows: remission (REM; DAS28-CRP <2.3), low disease activity (LDA; 2.3≤ DAS28-CRP <2.7), moderate disease activity (MDA; 2.7≤ DAS28-CRP ≤4.1), and high disease activity (HDA; DAS28-CRP >4.1). *p<0.05, **p<0.01, MTX (-) versus MTX (+), unpaired t-test in (A) and chi square-test comparing proportion of LDA in (B). (PNG 140 kb)

10067_2019_4581_MOESM1_ESM.tif (419 kb)
High resolution image (TIF 419 kb)
10067_2019_4581_MOESM2_ESM.docx (18 kb)
Supplementary Table 1 (DOCX 18 kb)

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Nobunori Takahashi
    • 1
    Email author
  • Toshihisa Kojima
    • 1
  • Daihei Kida
    • 2
  • Atsushi Kaneko
    • 2
  • Yuji Hirano
    • 3
  • Takayoshi Fujibayashi
    • 4
  • Yuichiro Yabe
    • 5
  • Hideki Takagi
    • 6
  • Takeshi Oguchi
    • 7
  • Masahiro Hanabayashi
    • 8
  • Takefumi Kato
    • 9
  • Koji Funahashi
    • 10
  • Masatoshi Hayashi
    • 11
  • Seiji Tsuboi
    • 12
  • Yasuhide Kanayama
    • 13
  • Yasumori Sobue
    • 1
  • Nobuyuki Asai
    • 1
  • Takuya Matsumoto
    • 1
  • Tatsuo Watanabe
    • 1
  • Shuji Asai
    • 1
  • Naoki Ishiguro
    • 1
  1. 1.Department of Orthopedic Surgery and Rheumatology, Nagoya University HospitalNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Orthopedic Surgery and RheumatologyNagoya Medical CenterNagoyaJapan
  3. 3.Department of RheumatologyToyohashi Municipal HospitalToyohashiJapan
  4. 4.Department of Orthopedic SurgeryKonan Kosei HospitalKonanJapan
  5. 5.Department of RheumatologyTokyo Shinjuku Medical CenterTokyoJapan
  6. 6.Department of Orthopedic SurgeryNagoya Central HospitalNagoyaJapan
  7. 7.Department of Orthopedic SurgeryAnjo Kosei HospitalAnjoJapan
  8. 8.Department of Orthopedic SurgeryIchinomiya Municipal HospitalIchinomiyaJapan
  9. 9.Kato Orthopedic ClinicOkazakiJapan
  10. 10.Department of Orthopedic SurgeryKariya–Toyota General HospitalKariyaJapan
  11. 11.Department of RheumatologyNagano Red Cross HospitalNaganoJapan
  12. 12.Department of Orthopedic SurgeryShizuoka Kosei HospitalShizuokaJapan
  13. 13.Department of Orthopedic SurgeryToyota Kosei HospitalToyotaJapan

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