BACKGROUND: There are substantial differences in accessibility to biological disease modifying antirheumatic drugs (bDMARDs) across countries. The objective of this study was to analyse the impact of patient demographics, disease characteristics and gross domestic product (GDP) on abatacept (ABA) retention in patients with rheumatoid arthritis (RA) treated in clinical practice. METHODS: Data from nine European observational RA cohorts of patients treated with ABA were pooled. Kaplan-Meier analysis was used to compare drug retention across registries. Specific causes of drug retention were investigated using competing risks multivariate Cox regression. RESULTS: A total of 3961 patients treated with ABA, with 6188 patient-years of follow-up, were included. Patients in the different national registries had similar demographic features, but varied in baseline disease characteristics. ABA drug retention differed between countries, with median drug retention rates ranging from 1.2 to more than 6 years. The differences in drug retention were marginally explained by disparities in disease characteristics, while the national GDP per capita was strongly associated with drug retention (correlation coefficient -0.74; p=0.02). CONCLUSIONS: Patient characteristics at ABA initiation vary across Europe, probably reflecting differences in eligibility criteria and prescription patterns. However, the difference in ABA drug retention between countries was not primarily explained by disparities in patient characteristics. Lower ABA retention was observed in countries with a more liberal access to bDMARDs and higher GDP. National differences need to be accounted for when pooling data on treatment with bDMARDs from various countries.

ARTIS Sweden ; Rheumatology Department of Clinical Sciences Malmö Lund University Malmö Sweden ; Department of Rheumatology Skåne University Hospital Malmö Sweden

ATTRA Czech Republic

BIOBADASER Spain

DANBIO Center for Rheumatology and Spine Diseases Rigshospitalet Glostrup Denmark ; Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Rheumatology Diakonhjemmet Hospital Oslo Norway ; NOR DMARD Norway

Department of Rheumatology ORA National Center for Rare Systemic Autoimmune Diseases Hôpitaux Universitaires de Strasbourg Université de Strasbourg France

DREAM The Netherlands

Geneva University Geneva Switzerland

GISEA Rheumatology Unit Interdisciplinary Department of Medicine University of Bari Italy

ORA Rhumatologie Hôpitaux Universitaires Paris Sud Le Kremlin Bicetre Université Paris Sud France

REUMA PT Portugal

SCQM RA Switzerland ; Geneva University Geneva Switzerland

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