Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival

Flouri, Irini; Markatseli, Theodora E.; Voulgari, Paraskevi V.; Boki, Kyriaki; Papadopoulos, Ioannis; Settas, Loukas; Zisopoulos, Dimitrios; Skopouli, Fotini N.; Iliopoulos, Alexios; Βertsias, George; Geborek, Pierre; Drosos, Alexandros A.; Boumpas, Dimitrios T.; Sidiropoulos, Prodromos

doi:10.1016/j.semarthrit.2013.07.011

Cited by 85 publications

(73 citation statements)

References 63 publications

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“…After adjusting for baseline confounding factors, we showed the overall higher drug survival of etanercept compared with both monoclonal antibodies, similarly to what is reported by the Lombardy Rheumatology Network (LORHEN) and GISEA registries and by a multicentric study carried out in France . At variance, some European studies did not find any significant difference between the 2 subcutaneous TNFi , whereas US reports showed greater drug survival on infliximab compared with both adalimumab and etanercept . These apparently discrepant findings might be due to differences in the baseline characteristics of the cohorts, in the regimen of administered treatments, or other methodologic variations.…”

Section: Discussionsupporting

confidence: 85%

Twelve‐Year Retention Rate of First‐Line Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: Real‐Life Data From a Local Registry

Favalli

Pregnolato

Biggioggero

et al. 2016

Arthritis Care & Research

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Objective. To evaluate the 12-year survival of the first tumor necrosis factor inhibitor (TNFi) treatment in a cohort of rheumatoid arthritis (RA) patients, comparing the between-groups discontinuation rates for infliximab, etanercept, and adalimumab. Methods. RA patients treated with their first TNFi were investigated from a local registry. Before and after adjusting for propensity scores, overall and by individual TNFi 12-year drug retention was evaluated. Drug survival rates were calculated using the Kaplan-Meier method and compared by the Cox extended model. Subanalyses were performed according to concomitant methotrexate (MTX) and discontinuation reasons. Results. Of 583 patients, 222 were treated with infliximab, 179 with etanercept, and 182 with adalimumab; 33.7% and 26% discontinued the first TNFi because of inefficacy or adverse events, respectively. The overall 12-year drug survival rate for the unmatched population was 23.4%. In the propensity score-adjusted population, the hazard ratio (HR) for treatment discontinuation was significantly greater for adalimumab and infliximab versus etanercept (HR 2.89 [95% confidence interval (95% CI) 2.2-3.78] and HR 2.56 [95% CI 1.92-3.4], respectively), and no difference was found between and for adalimumab versus infliximab (HR 1.16 [95% CI 0.91-1.47]). The incidence of withdrawal due to secondary inefficacy was stable from 3 to 12 years for etanercept, but progressively increased for the monoclonal antibodies. Concomitant MTX significantly increased the survival of both adalimumab and etanercept (HR 1.48 [95% CI 1.18-1.86]). Conclusion. The overall 12-year drug survival rate was 23.4%, being significantly higher for etanercept than adalimumab and infliximab. Etanercept discontinuations for inefficacy did not increase from 3 to 12 years. Concomitant MTX increased adalimumab and etanercept drug survival.

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Section: Discussionsupporting

confidence: 85%

Twelve‐Year Retention Rate of First‐Line Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: Real‐Life Data From a Local Registry

Favalli

Pregnolato

Biggioggero

et al. 2016

Arthritis Care & Research

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“…A possible explanation for these findings could be related to the high proportion of patients that received biological DMARDs which came to be used in more than a quarter of the population at the end of the observation period, which differs from the Brazilian and Colombian cohorts mentioned previously in which these were not used . It should be noted that these drugs have demonstrated excellent effectiveness in a wide range of patients, including those classed as difficult to control , despite being costly for any healthcare system and exhibiting a high incidence of adverse events . This explains the decision made by the treating team to use them in determined cases with proper justification .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Machado‐Alba

Ruiz²,

Machado‐Duque

2016

Int J Clin Pract

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Summary Aims Rheumatoid arthritis (RA) is an autoimmune disease cause of disability and high costs. To determine the effectiveness of therapy with biologic‐ and disease‐modifying antirheumatic drugs (DMARDs) in patients with RA and factors associated with the control of the disease. Methods Retrospective cohort study of RA patients receiving treatment with DMARDs in a rheumatologic healthcare institution in five Colombian cities from December 2009 to August 2013. The effectiveness was assessed by Disease Activity Score‐28 (DAS‐28) and a lower value of 2.6 was considered remission. Results A total of 827 patients were studied for an average observation period of 17.3 ± 11.0 months, with mean age 54.3 ± 13.1 years. The most frequently used DMARDs were methotrexate, leflunomide and chloroquine. The most frequently used biological DMARDs were etanercept and abatacept. Initially, 17.8% of the patients received some biological DMARDs in comparison with 28.7% at the end of the observation period. A median DAS28 of 3.5 was found, which was reduced by the end of the observation period to 2.8 (p < 0.001), and cases of patients who were in remission increased from 30.1% to 42.9%. Treatment with leflunomide (OR: 0.47; CI 95%: 0.35–0.64, p < 0.001) or rituximab (OR: 0.37; CI 95%: 0.17–0.83, p = 0.016) was associated with a lesser probability of reaching remission. To be treated in the city of Manizales (OR: 2.56; CI 95%: 1.36–4.82, p = 0.004) was associated with a high probability of remission. Conclusions Biological and DMARDs therapy for RA was effective in a relevant proportion of Colombian patients as a consequence of management with strategies set on remission aims quantified using DAS28. Cost‐effectiveness of the therapy must be evaluated.

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“…Until April 2015, nearly 3000 patients had been recruited in the registry. Details about its design and data collection protocol have been published elsewhere 11 . According to the national guidelines, treating rheumatologists are those who decide when a patient has to be treated with a biologic agent.…”

Section: Data Sourcementioning

confidence: 99%

“…Detailed protocol and variables collected are described elsewhere 11 . In patients with SpA, baseline characteristics additionally included current and/or a history of axial SpA (inflammatory back pain or radiological spondylitis/sacroiliitis) and/or peripheral arthritis (for lower limbs, defined as arthritis distal to the hip) based on the treating clinician's judgment.…”

Section: Data Sourcementioning

confidence: 99%

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Flouri

Markatseli²,

Boki³

et al. 2018

J Rheumatol

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Objective.To evaluate the 10-year drug survival of the first tumor necrosis factor inhibitor (TNFi) administered to patients with spondyloarthritis (SpA) overall and comparatively between SpA subsets, and to identify predictors of drug retention.Methods.Patients with SpA in the Hellenic Registry of Biologic Therapies, a prospective multicenter observational cohort, starting their first TNFi between 2004–2014 were analyzed. Kaplan-Meier curves and Cox regression models were used.Results.Overall, 404 out of 1077 patients (37.5%) discontinued treatment (followup: 4288 patient-yrs). Ten-year drug survival was 49%. In the unadjusted analyses, higher TNFi survival was observed in patients with ankylosing spondylitis (AS) compared to undifferentiated SpA and psoriatic arthritis [PsA; significant beyond the first 2.5 (p = 0.003) years and 7 years (p < 0.001), respectively], and in patients treated for isolated axial versus peripheral arthritis (p = 0.001). In all multivariable analyses, male sex was a predictor for longer TNFi survival. Use of methotrexate (MTX) was a predictor in PsA and in patients with peripheral arthritis. Absence of peripheral arthritis and use of a monoclonal antibody (as opposed to non-antibody TNFi) independently predicted longer TNFi survival in axial disease because of lower rates of inefficacy. Achievement of major responses during the first year in either axial or peripheral arthritis was the strongest predictor of longer therapy retention (HR 0.33, 95% CI 0.26–0.41 for Ankylosing Spondylitis Disease Activity Score inactive disease, and HR 0.35, 95% CI 0.24–0.50 for 28-joint Disease Activity Score remission).Conclusion.The longterm retention of the first TNFi administered to patients with SpA is high, especially for males with axial disease. The strongest predictor of longterm TNFi survival is a major response within the first year of treatment.

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Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival

Cited by 85 publications

References 63 publications

Twelve‐Year Retention Rate of First‐Line Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: Real‐Life Data From a Local Registry

Twelve‐Year Retention Rate of First‐Line Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: Real‐Life Data From a Local Registry

Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

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