Evidence map›Paper›PMID 33881676›Full record

ArticleClinical rheumatology2021

Retention rate of a second line with a biologic DMARD after failure of a first-line therapy with abatacept, tocilizumab, or rituximab: results from the Italian GISEA registry.

Marco Sebastiani, Vincenzo Venerito, Serena Bugatti, Chiara Bazzani, Martina Biggioggero, Luca Petricca, Rosario Foti, Alessandra Bortoluzzi, Silvia Balduzzi, Elisa Visalli and 8 more

Abstract read
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In one paragraph

Article in Clinical rheumatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Marco SebastianiRheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Via del Pozzo, 41125, Modena, Italy. marco.sebastiani@unimore.it.
Vincenzo VeneritoDepartment of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Bari, Italy.
Serena BugattiDivision of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
Chiara BazzaniUnit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy.
Martina BiggioggeroDepartment of Rheumatology, Gaetano Pini Institute, Milan, Italy.
Luca PetriccaDivision of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
Rosario FotiRheumatology Unit, A.O.U. Policlinico San Marco, Catania, Italy.
Alessandra BortoluzziSection of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy.
Silvia BalduzziDivision of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
Elisa VisalliRheumatology Unit, A.O.U. Policlinico San Marco, Catania, Italy.
Bruno FredianiRheumatology Unit, Department of Medical Sciences, Surgery e Neurosciences, University of Siena, Siena, Italy.
Andreina ManfrediRheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Via del Pozzo, 41125, Modena, Italy.
Elisa GremeseDivision of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
Ennio FavalliDepartment of Rheumatology, Gaetano Pini Institute, Milan, Italy.
Florenzo IannoneDepartment of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Bari, Italy.
Gianfranco FerraccioliDivision of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
Giovanni LapadulaDepartment of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Bari, Italy.
Contributors

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesEULAR recommendations do not suggest which biologic disease-modifying anti-rheumatic drug (bDMARD) should be preferred after failure of a first bDMARD in the treatment of rheumatoid arthritis (RA). In particular, few data are available regarding the effectiveness of a second-line bDMARD after failure of abatacept (ABA), tocilizumab (TCZ), and rituximab (RTX). The aim of this study was to analyze the retention rate of a second line with tumor necrosis factor inhibitors (TNFi) or other mechanisms of action (MoAs), after the failure of either RTX, TCZ, or ABA.

methodsTwo hundred and seventy-eight RA patients from the Italian GISEA registry were included in the study. RTX was the first bDMARD in 18% of patients, ABA in 45.7%, and TCZ in 36.3%, while the second bDMARD was a TNFi (group 1) in 129 patients and an agent with a different MoA (group 2) in 149.

resultsDuring a median follow-up of 22 months (IQR 68), 129 patients discontinued their treatment; patients of group 1 discontinued the treatment more frequently than patients of group 2 (p<0.001) with retention rates of 33.6±5.7% and 63.6±4.6% after 104 weeks for group 1 and group 2, respectively (p<0.001). At multivariate analysis, the mechanism of action was the only predictor for the maintenance in therapy.

conclusionsAccording to our data, ABA, RTX, and TCZ seem to maintain a good retention rate also when used as a second-line therapy, suggesting their use after the failure of a non-TNFi as first-line therapy. However, specifically designed studies are needed to evaluate the more appropriate therapeutic strategies in RA, according to the first-line drug, including new targeted synthetic DMARDs. Key Points • A large proportion of rheumatoid arthritis patients fail the first biologic DMARD. • Few data are available about the efficacy of biologic DMARD after the failure of a non-TNF inhibitor. • Abatacept, rituximab, or tocilizumab seem to maintain a good retention rate after the failure of a first-course therapy with a non-TNF inhibitor.

Indexed as

Antirheumatic AgentsBiological ProductsAbataceptAntibodies, Monoclonal, HumanizedHumansItalyRegistriesRituximabAbataceptAntibodies, Monoclonal, HumanizedAntirheumatic AgentsBiological ProductsRituximabtocilizumabAbataceptRetention rateRheumatoid arthritisRituximabTNF inhibitorsTocilizumab

Identifiers

PMID33881676

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.