Comment on: Comparative Effectiveness of Abatacept, Rituximab, Tocilizumab and TNFi Biologics in RA: Results from the Nationwide Swedish Register

OpenAlex · İngilizce

Sir, We read with great interest the recent article by Frisell et al. ‘Comparative effectiveness of abatacept, rituximab, tocilizumab and TNF inhibitors (TNFi) biologics in RA: results from the nationwide Swedish register’ [1]. The artricle has valuable information related to real-life RA management. It shows different aspects of biologic treatment when considering EULAR/ACR guidelines on biologic treatment of RA [2, 3]. In this study it is shown that non-TNFi had a similar or even better response rate on both TNFi-naïve and -resistant patients. However, we think it would be more appropiate if a janus kinase inhibitor, tofactinib, was added to this study, so that all drug groups recommended in the EULAR guideline could be assessed [3]. In fact, it is a well-known drug providing a good response rate in both first-line biologic and TNFi-resistant patients [4, 5]. Approval of tofactinib occurred later than other biologic drugs in the European Union, which might be the reason for it not being including. It was, however, still a comprehensive study with a large population and long follow-up. Another point that should be clarified is the efficacy and discontinuation rate as a result of lack of effect. Although it was written that in biologic-naïve patients, the difference vs TNFi was similar among patients remaining on each therapy at 1 year, rituximab had the least discontinuation rate in Fig. 1. Could this be attributable to better HAQ response rate, or is there another reason that was not mentioned in the text? Also, in the supplement it was shown that rituximab had the highest continution rate but the worst EULAR good response rate and DAS28 < 2,6. We would like to know the reason for continuing rituximab despite not having remission. Is it a result of patients’ characteristics such as obligatory comorbidities, tuberculosis or malignancies, which drive physicians’ decisions? Could it also be because of geographic locations, which render frequent appointments less likely? Continuation rate difference between treatment groups can be statistically non-meaningful though, which was not mentioned in the paper or in the supplement. Real-life study of large RA populations is always exciting. They have a contribution nearly as vaulable as guidelines to every day clinical practice. More systematically gathered country registiration data should be analysed as is done in this study, to shed light on RA patients’ management. Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript. Disclosure statement: The authors have declared no conflicts of interest.