Drug Retention Rates and Treatment Discontinuation among Anti-TNF-αAgents in Psoriatic Arthritis and Ankylosing Spondylitis in Clinical Practice

Abstract

Objective. The study aim was to determine treatment persistence rates and to identify causes of discontinuation in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients in clinical practice. Methods. Patients treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) were retrospectively included. Treatment persistence rates were analyzed by means of a stepwise logistic regression. Differences between therapy duration were assessed by means of an analysis of variance model (ANOVA), while a chi-square test was used to evaluate relationships between therapies and causes of treatment discontinuation and the administration of concomitant disease-modifying antirheumatic drugs (DMARDs) among therapies and types of disease considering completed courses of therapy versus courses that were discontinued. Results. 268 patients received a total of 353 anti-TNF treatment courses (97 ADA, 180 ETA, and 76 INF). Comparison among therapies showed significant difference regarding the treatment persistence rates due to the contrast between ETA and INF (P = 0.0062). We observed that 84.7% of patients were still responding after 6 months of follow-up. Comparison among diseases showed that there were significant differences between PsA and AS (P = 0.0073) and PsA and PsA with predominant axial involvement (P = 0.0467) in terms of duration of the therapy, while there were no significant differences with regard to the persistence rate. Conclusions. In this cohort, anti-TNF-α therapy was associated with high drug persistence rates. As in rheumatoid arthritis, switching to another anti-TNF-α agent can be an effective option when, during the treatment of AS or PsA, therapy is suspended because of inefficacy or an adverse event. Combination therapy with DMARDs was associated with a better persistence rate.

Treatment patterns of biologics in US patients with ankylosing spondylitis: descriptive analyses from a claims database

“…TNFi-iv. In the findings reported here, the discontinuation rate (31%) was similar to the discontinuation rate (34%) in a previous study of TNFis in patients with AS [23]; however, the rate of switching to a new TNFi (21%) fell between the results of previous studies (4-30%) [23,24,32]. Previous studies have confirmed that while switching to a second TNFi can be effective in AS, overall effectiveness may be somewhat lower [21,33,34].…”

“…The percentage of patients in this study who discontinued or switched TNFis (59.4%) was higher than in the previous studies [22][23][24]32]. Although the current study did not evaluate the reasons patients switched or discontinued TNFi therapy, previous studies have shown that approximately 30-36% of patients with AS, discontinued or switched biologic therapy because of adverse events [35,36] or lack of treatment effect [37].…”

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“…For example, biologics registries have provided invaluable data about treatment switching and long-term drug retention rates, which reflects efficacy, safety and adherence to the drug [28][29][30]. They helped elucidate the very debated association between biologics and malignancies and provided solid reassurance about this major safety issue [31][32].…”

National Rheumatology Summit. Place of adalimumab in current pharmacotherapy strategy for rheumatoid arthritis

“…Так, в исследовании с участием 268 пациентов с ревматическими заболеваниями анализ причин отмены иФНОα показал, что частота пре-кращения лечения из-за появления НР значимо не различа-ется у препаратов этой группы [14]. Наиболее частыми НР были инфузионные реакции, инфекции, печеночная, по-чечная или гематологическая дисфункции, сердечно-сосу-дистые, неврологические и психотические нарушения, зло-качественные новообразования.…”