Comparative efficacy of tocilizumab, abatacept and rituximab after non-TNF inhibitor failure: results from a multicentre study.

Aims: 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).

Materials And 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.