Abatacept vs Tocilizumab for the Treatment of RA in TNF Alpha Inhibitor Inadequate Responders
Status:
Recruiting
Trial end date:
2022-11-01
Target enrollment:
Participant gender:
Summary
Rheumatoid arthritis (RA) is the most common inflammatory rheumatoid disease in France,
affecting 0.3% of the general population. Without effective treatment, the persistent
inflammation causes invalidating pain and joint destruction, leading to major functional
disability.
Biological agents have been proposed for patients with RA who have the most severe form of
the disease and that are inadequate responder patients to conventional synthetic
Disease-modifying antirheumatic drugs (csDMARDs). TNF inhibitors (TNFi) are historically
proposed as the first biological DAMRD for inadequate responder patients to csDMARDs. A
diverse therapeutic arsenal has become available in recent years with the development of
non-anti-TNFα drugs whose mechanisms of action are different from the classical TNFi. This
new biotherapy class includes tocilizumab and abatacept, two drugs recently available for
subcutaneous administration that enables ambulatory care for patients who would otherwise
require repeated in-hospital care.
The role of these new treatments in the therapeutic strategy has been emphasized by studies
that demonstrated their efficacy as first-line treatments. However, in clinical practice,
TNFi remain the most common first-line treatment for the majority of patients, non-anti-TNFα
biological agents being reserved for inadequate responder patients.
In second line, several studies have investigated therapeutic strategies for inadequate
responder patients to TNFi. Current data suggest that it could be wise to change the
therapeutic target after failure of a first-line treatment with TNFi.
Data about the comparative efficacy of different biologics proposed after failure of a
first-line treatment with TNFi are in progress. Meta-analyses from registries and academic
trials conducted in France and The Netherlands suggest that non-anti-TNFα agents would have
equivalent or superior efficacy compared with a second TNFi. This finding suggests clinicians
to switch for an alternate therapeutic target after failure of a first-line TNFi.
Data comparing different non-anti-TNFα biologics in inadequate responder patients to TNFi are
scare. Industrial trials have demonstrated sustained biological efficacy of non-anti-TNFα
biologics after failure of a TNFi. However, there is very little solid data on the direct
comparison between them.