Background and importance Abatacept (ABA) is indicated as firstline treatment in patients diagnosed with moderate–severe active rheumatoid arthritis (RA). Persistence of ABA in patients diagnosed with RA and the prognostic factors that are associated with treatment discontinuation may help optimise its use.

Aim and objectives To assess the persistence of abatacept and identify factors that contributes to its discontinuation in patients diagnosed with RA.

Material and methods A retrospective, observational, cohort study was conducted in RA patients treated with ABA between 2009 and 2019 (n=190). Sociodemographic, clinical and pharmacological characteristics of patients were collected. Clinical disease activity indicated by disease activity score (DAS) 28-ESR as well as adverse drugs effects (AEs) were evaluated. Kaplan–Meier survival analysis was used to obtain the time to discontinuation, and the log rank test was used to examine the difference in therapy continuation rate. Cox proportional hazards model was used to identify factors associated with durability.

Results 190 RA patients were evaluated; 75.26% (143/190) were women, disease duration was 14 (8–20) years and age at the start of ABA was 58.5 (49.25–68) years. Overall, 96.16% (177/190) had concomitant therapies with ABA (methotrexate, leflunomide, hydroxychloroquine). A total of 22.11% (42/190) were bionaive, 26.32% (50/190) began treatment after failure of one tumour necrosis factor inhibitor (TNFi) and 51.57% (98/190) began treatment with ABA after failure of two or more TNFis. The causes of ABA withdrawal were therapeutic failure in 28.95% (55/190) and adverse effects in 13.15% (25/190). Infections were the most frequent AEs (56.3%). Median persistence of ABA was 65 (95% CI 45 to 116) months. Kaplan–Meier analysis showed a trend of high persistence of ABA in naïve patients (89 months) compared with patients with one, or two or more previous biological therapies (TBs) (89 vs 65 and 29 months, respectively) (log rank p=0.06). According to Cox’s model, duration of disease, duration of previous TB and number of previous TBs were associated with a higher risk of treatment interruption (log rank p=0.002).

Conclusion and relevance Median duration of ABA persistence was 65 months. Factors associated with the duration of the disease as well as previous biological therapies influenced the persistence of ABA.

Conflict of interest No conflict of interest