Drug survival on TNF inhibitors in patients with rheumatoid arthritis comparison of adalimumab, etanercept and infliximab

Abstract

ObjectiveTo compare drug survival on adalimumab, etanercept and infliximab in patients with rheumatoid arthritis (RA).MethodsPatients with RA (n=9139; 76% women; mean age 56 years) starting their first tumour necrosis factor (TNF) inhibitor between 2003 and 2011 were identified in the Swedish Biologics Register (ARTIS). Data were collected through 31 December 2011. Drug survival over up to 5 years of follow-up was compared overall and by period of treatment start (2003–2005/2006–2009; n=3168/4184) with adjustment for age, sex, education, period, health assessment questionnaire (HAQ), disease duration, concomitant disease modifying antirheumatic drug (DMARD) treatment and general frailty (using hospitalisation history as proxy).ResultsDuring 20 198 person-years (mean/median 2.2/1.7 years) of follow-up, 3782 patients discontinued their first biological (19/100 person-years; 51% due to inefficacy, 36% due to adverse events). Compared with etanercept, infliximab (adjusted HR 1.63, 95% CI 1.51 to 1.77) and adalimumab initiators had higher discontinuation rates (1.26, 95% CI 1.16 to 1.37), and infliximab had a higher discontinuation rate than adalimumab (1.28, 95% CI 1.18 to 1.40). These findings were consistent across periods, but were modified by time for adalimumab versus etanercept (p<0.001; between-drug difference highest the 1st year in both periods). The discontinuation rate was higher for starters in 2006–2009 than 2003–2005 (adjusted HR 1.12, 95% CI 1.04 to 1.20). The composition of 1-year discontinuations also changed from 2003–2005 vs 2006–2009: adverse events decreased from 45% to 35%, while inefficacy increased from 43% to 53% (p<0.001).ConclusionsDiscontinuation rates were higher for infliximab compared with adalimumab and etanercept initiators, and for adalimumab versus etanercept during the 1st year. Discontinuation rates increased with calendar period, as did the percentage discontinuations due to inefficacy.

Drug survival for ciclosporin A in a long-term daily practice cohort of adult patients with atopic dermatitis

“…8,9 More recently, literature about the drug survival of patients with psoriasis treated with biologics has been published. 10,11 To the best of our knowledge, this is the first study on drug survival in patients with AD treated with CsA in daily practice.…”

Circulating complexes between tumour necrosis factor‐alpha and etanercept predict long‐term efficacy of etanercept in juvenile idiopathic arthritis

“…Drug survival time is a composite measure, integrating, among other things, both efficacy and tolerance to therapy. Drug survival has been used in several studies and has been shown to be a clinically relevant measurement for long‐term drug efficacy 13, 14.…”

Pharmaceutical aspects of anti-inflammatory TNF-blocking drugs

“…The relative efficacy of these agents in various conditions are still not clear as there are no randomized controlled trials to date that compared the clinical efficacy or safety head-to-head of these five agents in any one inflammatory condition (PubMed search, January 17, 2015). However, there are studies that compared two of these drugs or compared one of these drugs with non-biologic, conventional DMARDs (Kievit et al 2007;Neovius et al 2015;Rau 2010). There are also several meta-analysis studies that indirectly compared the efficacy and safety of these five agents in the treatment of rheumatoid arthritis (Aaltonen et al 2012;Behrens et al 2014;Michaud et al 2014;Machado et al 2013).…”