ACR 2016 – Day 2 Highlights Save

Some big highlights from Monday included:

• Dr. Phillip Hench Lecture by Dr. Charles Dinarello who spoke about IL-1 and cancer. See the RheumNow Video of Dr. Dinarello
• Plenary session talk on rituximab being superior to azathioprine in maintaining remission in long term follow-up of ANCA-Associated vasculitis – the MAINRITSAN study.
• Multiple poster presentations and a session devoted to ACR Workforce Study. See Dr. Chad Deal's RheumNow video for more detail.

There were 2 other interesting oral presentations on Monday falling under the heading of drug safety and cost efficacy.

Best to Switch to a Non-TNFi Biologic. Dr. Jeff Curtis presented his abstract #1999 on the cost-effectiveness of switching from a TNF inhibitor (TNFi) to either another TNFi (cycler) or a non-TNFi biologic (switcher).  

This abstract set out to establish, from a payor's perspective, what the most cost-effective choice would be after failing one or more TNF blockers. Using a claims commercial database, they identified over 8000 patients who were TNFi cyclers or new MOA switchers.

The cyclers could have chosen either etanercept, adalimumab, golimumab, certolizumab or infliximab. The new MOA switchers could've chosen abatacept, tocilizumab or tofacitinib.

Effectiveness was based on an algorithm that required DMARD changes/increases, no steroid increase and very few intrarticular injections. This definition has been shown to have a PPV of 76% and a NPV of 90%.

In the end, the new MOA switchers had significantly more effective outcomes (26%) compared to those treated as TNFi cyclers (23%). Effectiveness was more common if background methotrexate was present. Lastly, the new MOA switchers had a significantly lower total cost of care compared to the cyclers.

These data are similar to that seen in the recently published ORBIT trial and other recent trials that show continued TNFi switching is less likely to be effective compared to the use of another MOA biologic.

Cancer Recurrence with Biologic Therapy. Another interesting study (abstract 2000) was presented by Gottenburg et al. on the incidence of cancer recurrence in patients with a prior history of cancer who were subsequently treated with either rituximab (RTX) or abatacept (ABA). Two French registries (AIR the ORA) were analyzed.

Among over 3000 patients, they identified 270 patients with a prior history of cancer treated with RTX and 55 prior cancer patients who were treated with ABA. These groups were analyzed for the occurrence of a new or recurrent cancer going forward.

There were 114 new cancers arising in the RTX patients and 48 cancers arising in the ABA treated patients. In the RTX patients the incident rate of a new cancer was either 2.0 (relapse) or 1.4 (new) compared to control patients who had a rate of 0.9 per 100 patient-years.

The ABA treated patients had cancer recurrence rate of 1.2 (relapse) or 0.8 (new) compared to 1.3/100 PY in the controls.

The authors concluded that: 1) cancer recurrence is more frequent in those with a history of cancer; 2) RA patients have more cancer than the general population; and 3) there's a comparable incidence of RTX an ABA related cancers that was not higher than the comparator population.