Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study [利妥昔单抗、阿巴西普和妥珠单抗对于成人类风湿性关节炎和TNF抑制剂反应不足的疗效比较：前瞻性队列研究]

• 分享：

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l67 (Published 24 January 2019)
Cite this as: BMJ 2019;364:l67

Authors
Jacques-Eric Gottenberg, Jacques Morel, Elodie Perrodeau, Thomas Bardin, Bernard Combe, Maxime Dougados, Rene-Marc Flipo, Alain Saraux, Thierry Schaeverbeke, Jean Sibilia, Martin Soubrier, Olivier Vittecoq, Gabriel Baron, Arnaud Constantin, Philippe Ravaud, Xavier Mariette

Abstract
Objective To compare the effectiveness and safety of three non-tumour necrosis factor (TNF) α inhibitors (rituximab, abatacept, and tocilizumab) in the treatment of rheumatoid arthritis.

Design Population based prospective study.

Setting 53 university and 54 non-university clinical centres in France.

Participants 3162 adults (>18 years) with rheumatoid arthritis according to 1987 American College of Rheumatology criteria, enrolled in one of the three French Society of Rheumatology registries; who had no severe cardiovascular disease, active or severe infections, or severe immunodeficiency, with follow-up of at least 24 months.

Intervention Initiation of intravenous rituximab, abatacept, or tocilizumab for rheumatoid arthritis.

Main outcome measure The primary outcome was drug retention without failure at 24 months. Failure was defined as all cause death; discontinuation of rituximab, abatacept, or tocilizumab; initiation of a new biologic or a combination of conventional disease modifying antirheumatic drugs; or increase in corticosteroid dose >10 mg/d compared with baseline at two successive visits. Because of non-proportional hazards, treatment effects are presented as life expectancy difference without failure (LEDwf), which measures the difference between average duration of survival without failure.

Results Average durations of survival without failure were 19.8 months for rituximab, 15.6 months for abatacept, and 19.1 months for tocilizumab. Average durations were greater with rituximab (LEDwf 4.1, 95% confidence interval 3.1 to 5.2) and tocilizumab (3.5, 2.1 to 5.0) than with abatacept, and uncertainty about tocilizumab compared with rituximab was substantial (−0.7, −1.9 to 0.5). No evidence was found of difference between treatments for mean duration of survival without death, presence of cancer or serious infections, or major adverse cardiovascular events.

Conclusion Among adults with refractory rheumatoid arthritis followed-up in routine practice, rituximab and tocilizumab were associated with greater improvements in outcomes at two years compared with abatacept.