J Rheum Dis.  2024 Oct;31(4):212-222. 10.4078/jrd.2024.0026.

Anemia as an indicator of a higher retention rate for tocilizumab versus tumor necrosis factor inhibitors in patients with rheumatoid arthritis from a Korean multicenter registry

• Kim JG
• Koo BS
• Lee JH
• Yoon BY

• KMID: 2559890
• DOI: http://doi.org/10.4078/jrd.2024.0026

Abstract

Objective
To examine whether simple laboratory tests can guide selection between tocilizumab (TCZ) and tumor necrosis factor inhibitors (TNFi) in biologic-naive patients with rheumatoid arthritis (RA), by investigating their influence on drug retention.
Methods
Data of RA patients prescribed TCZ or TNFi as the initial biologics from March 2013 to December 2021 were obtained from the KOrean College of Rheumatology BIOlogics and Targeted Therapy (KOBIO) registry. Propensity score matching was performed to adjust for baseline confounding factors. Hazards of drug discontinuation for TCZ were calculated compared to those for TNFi. Interaction analyses with a Bonferroni-corrected p-value threshold were conducted to determine whether the hemoglobin level, C-reactive protein level, erythrocyte sedimentation rate, and platelet count affected the hazards of drug discontinuation.
Results
Overall, 893 patients were analyzed, of whom 315 and 578 were treated with TCZ and TNFi, respectively. The hazards of drug discontinuation in all patients were lower for TCZ than for TNFi (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44~0.66). Notably, only the presence of anemia indicated a significant interaction (p for interaction=0.010); the HRs for drug discontinuation were 0.41 (95% CI: 0.30~0.55) and 0.70 (95% CI: 0.53~0.92) in the anemic and non-anemic groups, respectively. In the anemic subgroup, biologics were discontinued because of a lack of efficacy in 35.0% of TNFi initiators and 7.4% of TCZ initiators.
Conclusion
The drug discontinuation rate in biologic-naïve patients with RA was significantly lower for TCZ than for TNFi, particularly in those with anemia.

Keyword

Rheumatoid arthritis; Tocilizumab; Tumor necrosis factor inhibitors; Anemia

Figure

• 

  Figure 1 Patient selection process. KOBIO registry: Korean College of Rheumatology BIOlogics and Targeted Therapy Registry, b/tsDMARDs: biologic or targeted synthetic disease-modifying antirheumatic drugs, TCZ: tocilizumab, TNFi: tumor necrosis factor inhibitors, PS-matching: propensity score matching, ILD: interstitial lung disease.

• 

  Figure 2 Comparison of drug retention rates between TCZ and TNFi in biologic-naïve RA patients. (A) Kaplan–Meier curves comparing drug retention rates between TCZ and TNFi initiators with the HR of drug discontinuation for TCZ versus TNFi. (B) Percentage of cause-specific drug discontinuation among total patients during the entire follow-up period. TCZ: tocilizumab, TNFi: tumor necrosis factor inhibitors, RA: rheumatoid arthritis, HR: hazard ratio, CI: confidence interval.

• 

  Figure 3 Cox regression analyses for the interaction between laboratory markers and choice of biologics. TCZ: tocilizumab, TNFi: tumor necrosis factor inhibitors, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, CI: confidence interval. *p for interaction <0.0125.

• 

  Figure 4 Comparison of drug retention rates between TCZ and TNFi in the subgroups with or without anemia. (A) Kaplan–Meier curves comparing the drug retention rates between TCZ and TNFi initiators with the HR of drug discontinuation for TCZ versus TNFi in anemic subgroup. (B) Kaplan–Meier curves comparing the drug retention rates between TCZ and TNFi initiators with the HR of drug discontinuation for TCZ versus TNFi in non-anemic subgroup. (C) Percentage of cause-specific drug discontinuation among anemic subgroups during the entire follow-up period. (D) Percentage of cause-specific drug discontinuation among non-anemic subgroups during the entire follow-up period. TCZ: tocilizumab, TNFi: tumor necrosis factor inhibitors, HR: hazard ratio, CI: confidence interval.

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