TNF‐α Antagonist Survival Rate in a Cohort of Rheumatoid Arthritis Patients Observed under Conditions of Standard Clinical Practice

Abstract

A cohort of rheumatoid arthritis (RA) patients in the Lombardy Rheumatology Network (LOHREN) registry and receiving anti-TNF therapy was evaluated after 6, 12, 24, and 36 months. Of the 1114 patients in the registry 1064 met the clinical criteria for inclusion with 519 receiving infliximab, 303 adalimumab, and 242 etanercept. The therapeutic survival curve of these patients showed that the likelihood of continuing anti-TNF therapy was 78.8% after 12 months, 65.2% after 24 months, and 52.9% after 36 months, with a risk of dropout similar for inefficacy and adverse events. There were 405 anti-TNF therapy discontinuations (38.1%): 180 (16.9%) due to inefficacy, 194 (18.2%) adverse events, and 31 (2.9%) other reasons. Four deaths (2 septicemia, 1 postinfective cerebritis, 1 heart failure) were considered to be related to anti-TNF therapy. Of the discontinuations, 219 (54.1%) occurred within the first 12 months: 110 due to adverse events, 89 inefficacy, and 20 due to other reasons. After 36 months, the likelihood of survival on etanercept (62.5%) was significantly greater than the likelihood of survival on infliximab (49.1%) or adalimumab (53.6%). A higher risk of therapy discontinuations due to adverse events was associated with increasing age, a corticosteroid > 5 mg/day, a high erythrocyte sedimentation rate (ESR), a higher risk of therapy discontinuations due to inefficacy was associated with the previous use of > or = 4 disease-modifying antirheumatic drugs (DMARDs) and a high ESR. Comorbidities, increasing DAS28 values and co-therapy with methotrexate were associated with a lower risk of discontinuation.

Estratégia de troca entre agentes anti-TNF-alfa não melhora a capacidade funcional em pacientes com artrite reumatoide de longa evolução

“…Several causes can justify switching between Table 4 Clinical and laboratory characteristics of the groups with low and moderate/high disease activity, according to fi nal DAS28, after switching between anti-TNF-alpha agents anti-TNF-alpha agents of the same class or with a similar mechanism of action; however, usually the failure in responding (PF or SF) and the AEs are the major causes in most clinical studies published. 1,2 Similarly to the present study, Marchesoni et al, 13 in a large cohort of patients on anti-TNF-alpha therapy, have reported that of the 1,064 individuals assessed, 38.1% discontinued the medication. Of those, 44.4% discontinued due to ineffi cacy, 47.9% due to AEs, and 2.5% due to disease remission.…”

“…The greatest risk of discontinuing therapy due to some AE was associated with advanced age and current use of GC; while the loss of effi cacy was associated with previous use of more than three DMARDs and higher ESR. 13 In 40.5% of our patients, the reason for switching the anti-TNF-alpha agent was the presence of an AE. Usually, high retention rate of the second anti-TNF-alpha agent is observed in the fi rst year (50%-70%), and switching from one anti-TNFalpha agent to another can elicit an adequate clinical response, especially if caused by toxicity, as shown in a recent systematic review that assessed approximately six thousand patients.…”

“…That frequency is slightly higher than that reported by other authors, mainly those data originating from studies of registries, in which 25%-40% of the patients discontinue treatment in the fi rst 12 months due to loss of effi cacy or AEs. [1][2][3][11][12][13] It is worth emphasizing that the long duration of disease and the high prevalence of individuals with erosive disease, although with moderate physical incapacity, characterized this cohort. Such aspects can explain the higher prevalence of that strategy.…”

Treatment Patterns in the First Year After Initiating Tumor Necrosis Factor Blockers in Real-World Settings

“…Two of the studies analyzed rates of switching between TNF blockers [10,11], and others focused on treatment persistence [12][13][14][15][16][17][18][19]. None of the studies analyzed rates of restarting the index TNF blocker after a treatment gap.…”

TNF-α in the cardiovascular system: from physiology to therapy

“…165 These disorders are often associated with an increased risk of cardiovascular comorbidities, and the benefits of TNF-α inhibition, apart from anti-inflammatory efficacy and improved survival, 166 are thought to include cardiovascular protection. Consequently, many studies have been conducted to investigate the vascular effects of TNF-α inhibition in these patients, and they have produced an abundance of controversial results.…”