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Abstract
Objective
To estimate drug persistency and the safety of TNF blocker in Korean patients with rheumatoid arthritis.
Methods
Data were extracted from medical records of rheumatoid arthritis patients who had treated with TNF blocker or are currently using TNF blocker at Hanyang University Hospital for Rheumatic Diseases from Decem-ber 2000 to November 2009 (REtrospective study for Safety and Efficacy of Anti-RA treatment with biologiCs, RESEARCh). Comprehensive chart reviews were under-taken on all patients and data on drug usages and response of TNF blocker was collected at initiation, 3 months and the time of data collection. Persistency with treatment was examined using life-table analysis and multivariate Cox proportional hazard models were developed to examine potential predictors of discontinuation of TNF blocker.
Result
A total of 268 patients were enrolled in this retrospective study. Among them 180 patients were included in the analysis of drug persistency. The 1-year and 5-year drug persistency of TNF blocker was 74% and 46%, respectively. Concomitant use of methotrexate (hazard ratio 0.46, 95% CI 0.27-0.80) was associated with higher persistence. Comparing to etanercept, adalimumab is an independent risk factor for discontinuation (hazard ratio 2.63, 95% CI 1.43-4.84).
References
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Figure 2.
Response at 3 months. (A) DAS28 change during first 3 months, (B) Response at 3 months using EULAR response criteria, ∗DAS 28 means 3-variable DAS28 using tender joint count, swollen joint count and ESR.
Figure 3.
Drug persistency for TNF blocker in the patients with rheumatoid arthritis. (A) Drug persistency for the total TNF blocker, (B) Drug persistency for each TNF blocker, p=0.007 etanercept vs. adalimumab by Gehan's Wilcoxon method.
Table 1.
Demographic and clinical features in rheumatoid arthritis patients with TNF blockers
| Subjects for analysis (total n=180) | Number, Mean± SD | Etanercept (n=107) | Adalimumab (n=58) | Infliximab (n=15) | p |
|---|---|---|---|---|---|
| Age at start (years) | 50.5±13.2 | 51.4±12.9 | 48.8±12.9 | 51.3±16.2 | 0.47 |
| Female, No (%) | 155 (86.1) | 92 (86.0) | 51 (87.9) | 12 (80.0) | 0.73 |
| Disease duration at start (years) | 9.5±6.6 | 9.6±6.3 | 9.3±7.0 | 9.5±7.9 | 0.97 |
| RF positive ever, No (%) (n=180) | 130 (72.2) | 83 (77.6) | 36 (62.1) | 11 (73.3) | - |
| Anti-ccp positive, No (%) (n=96) | 83 (86.5) | 36 (85.7) | 44 (88.0) | 3 (75) | - |
| Treatment duration (months) | 26.0±22.3 | 32.2±22.7 | 12.5±8.2 | 33.9±32.9 | <0.001∗ |
Table 2.
Cox proportional hazard analysis for discontinuation
| Variable | HR | 95% CI | p-value | ||
|---|---|---|---|---|---|
| Drug | Infliximab | 1.46 | 0.56∼3.84 | 0.44 | |
| Adalimumab | 2.63 | 1.43∼4.84 | 0.002 | ||
| Etanercept | 1 | ||||
| Gender (Female) | 1.63 | 0.69∼3.82 | 0.26 | ||
| Comorbidity (+) | 0.88 | 0.46∼1.69 | 0.56 | ||
| Disease duration at start∗ | 0.96 | 0.92∼1.01 | 0.08 | ||
| Age at starting TNF blockers | <40 | 1 | |||
| 40∼49 | 1.68 | 0.76∼3.70 | 0.20 | ||
| 50∼59 | 1.06 | 0.49∼2.30 | 0.88 | ||
| 60≤ | 1.28 | 0.58∼2.86 | 0.54 | ||
| Concomitant use of MTX | 0.46 | 0.27∼0.80 | 0.005 | ||
Table 3.
Reasons for discontinuation of TNF blocker users
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