Journal List > J Rheum Dis > v.18(3) > 1063905

Cho, Sung, Choi, Uhm, Kim, Jun, Yoo, and Bae: Treatment Persistence with TNF Blocker in Korean Rheumatoid Arthritis Patients

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).

Conclusion

Five-year drug persistency of TNF blocker was 46% and concomitant use of methotrexate is associated with higher persistence.

References

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Figure 1.
Flow chart of patients included in the analysis.
jrd-18-161f1.tif
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.
jrd-18-161f2.tif
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.
jrd-18-161f3.tif
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

RF: rheumatoid factor,

Significant difference between etanercept and adalimumab based on Tukey's multiple comparison test

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

HR: harzard ratio,

Time duration from diagnosis of RA to beginning of TNF blocker

Table 3.
Reasons for discontinuation of TNF blocker users
Reasons for discontinuation All TNF blocker users (n=180), 390 PY Etanercept (n=107), 287.3 PY Adalimumab (n=58), 60.3 PY Infliximab (n=15), 42.4 PY
Adverse events, N (%) 11 (6.1) 5 (4.7) 6 (10.3) 2 (13.3)
 Puffy face, N 1 1    
 Skin eruption, N 2 2    
 Infection, N 2 1 1  
 Malignancy, N 5 1 3 1
 Headache, N 2 1 1  
 Pulmonary nodule/dyspnea, N 2   1 1
Inefficacy, N (%) 20 (11.1) 7 (6.5) 9 (15.5) 4 (26.7)
Intention of patients, N (%) 22 (12.2) 17 (15.9) 5 (8.6) 0
Operation and hospitalization, N (%) 8 (4.4) 7 (6.5) 1 (1.7) 0
Follow up loss, N (%) 11 (6.1) 5 (4.7) 5 (8.6) 1 (6.7)

PY: person-year

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