Ab0690 Comparison of the Efficacy of Etanercept Versus Monoclonal TNF Inhibitors in Patients With Rheumatoid Arthritis in the Czech National Attra Registry

Background: There are many effective treatment options for rheumatoid arthritis (RA), but relatively less evidence to support the use of any one bDMARD or drug class over another. Further research is needed, as well as rigorous analysis of data from real-world clinical practice, to determine whether specific subgroups of patients may benefit from specific drug. Objectives: The aim of this study was to compare the results of treatment of patients with RA with etanercept versus monoclonal anti-TNF inhibitors (TNFi) initiating first-line therapy in routine clinical practice using data from the national ATTRA registry in the Czech Republic Methods: Patients with RA who started first-line biological therapy from January 2012 to June 2020 from the Czech ATTRA registry were included in the study and were divided into two groups either treated with etanercept (ETA) or another TNFi. Patients were examined at the start of treatment and after 3, 6, 12, 18 and 24 months. The endpoints monitored were survival on treatment, DAS 28, ESR, response to treatment according to EULAR, HAQ, SF-36, physician assessment and work capacity. Remission was defined as a disease activity score 28 (DAS 28) ESR < 2.6 and low disease activity (LDA) as 2.6 ≤ DAS28-ESR ≤ 3.2. Survival on treatment was calculated using. Kaplan-Meiers method. Statistical analyses were performed using IBM SPSS Statistics software (version 25.0). Absolute and relative frequencies for categorical variables, means with standard deviation (SD) and medians with 5th and 95th percentiles after describing continuous variables were evaluated. Results: A total of 2754 patients were enrolled in this study and followed from January 2012 to June 2020.Of these patients, 726 (557 women, 76.7%) were treated with etanercept (ETA) and 2028 (1579 women, 77.9%) with other TNFi. At each time point, there was no significant difference in survival between patients on ETA treatment compared with other TNFi (Figure 1). The median survival time for ETA was 44.6 (95% CI 37.0; 52.2) months compared with 36.8 (95% CI 27.9; 45.6) months for TNFi. Reasons for treatment discontinuation were primary loss of effect (secondary failure) of ETA 26.7% and 31.38%, and ineffectiveness (primary failure) of other TNFi 16.8% and 22.9%, respectively. No significant difference between groups. There was a significant improvement in physical function and quality of life scores (HAQ, SF 36 and EuroQuol) but no statistically significant difference between the treated groups. Remission (DAS28-ESR < 2.6) and low disease activity (LDA 2.6 ≤ DAS28-ESR ≤ 3.2) were achieved by 45.5%, 22.7%, 59.2% and 13.4% of patients on ETA at 12 and 24 months, respectively. In the group of patients treated with other TNFi, 44.5% and 21.7% achieved remission and LDA at 12 months and 46.9% and 25.2% at 24 months (Figure 2). The only statistically significant value was remission on ETA compared to other TNFi. at 24 months (p=0,005). However, when evaluating the percentage of patients in remission and low clinical activity, the values were the same. Conclusion: These results from the Czech ATTRA registry support the consensus of current RA treatment guidelines, which state that adopting an individualized treatment approach may be more important than the specific use of a single bDMARD or mechanism of action. Results vary slightly over time depending on the method of assessment used. Future real-world observational studies should aim to identify specific factors to predict response to treatment and/or stratify the relative efficacy of bDMARDs by specific line of treatment. REFERENCES: NIL. Acknowledgements: This work was supported by the project MHCR (Ministry of Health Czech Republic) for consensual development of research organization 023728.MHCR (/ 023728 and AZV No. 18-00542. Disclosure of Interests: Olga Sleglova Janssen, Sandos, Lucie Nekvindova: None declared, Jakub Zavada Abbvie, Elli Lilly, Sandoz, Novartis, Egis, UCB.