Background: We compared the effectiveness of abatacept (ABA) vs tocilizumab (TCA) in tumor necrosis factor\ninhibitor (TNFi) experienced patients.\nMethods: We identified rheumatoid arthritis (RA) patients from a large observational US cohort (1 January 2010ââ?¬â??31\nMay 2014) who had discontinued at least one TNFi and initiated ABA or TCZ in moderate or high disease activity based\non the Clinical Disease Activity Index (CDAI) and had no prior exposure to the comparator drug. Using propensity score\nmatching (1:1) stratified by prior TNF use (1 TNFi vs ââ?°Â¥2 TNFis), effectiveness at 6 months after initiation was evaluated.\nMean change in CDAI over 6 months following initiation was the primary outcome, with secondary outcomes of\nachievement of low disease activity/remission (CDAI ââ?°Â¤ 10) and mean change in modified Health Assessment\nQuestionnaire (mHAQ) score.\nResults: The 264 pairs of propensity score-matched ABA and TCZ initiators were well matched with no substantial\ndifferences in the baseline characteristics, defined as standardized differences >0.1 in the stratification. Both treatment\ngroups had similar mean change in CDAI at 6 months (ââ?¬â??11.3 in ABA vs ââ?¬â??9.9 in TCZ; mean difference ââ?¬â??1.27, 95% CI ââ?¬â??3.\n65, 1.11). Similar proportions of both treatment groups achieved low disease activity/remission (adjusted odds ratio for\nABA vs TCZ 0.99, 95% CI 0.69, 1.43). Mean change in mHAQ was ââ?¬â??0.12 in ABA initiators vs ââ?¬â??0.11 in TCZ initiations (mean\ndifference ââ?¬â??0.01, 95% CI ââ?¬â??0.09, 0.06).\nConclusions: Patients receiving either ABA or TCZ had substantial improvement in clinical disease activity. In this\npropensity score-matched sample, similar outcomes were observed for both treatment cohorts
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