Comparative Persistence of the TNF Antagonists in Rheumatoid Arthritis – A Population-Based Cohort Study

Abstract

ObjectiveTo compare persistence with tumor necrosis factor alpha (TNF) antagonists among rheumatoid arthritis patients in British Columbia. Treatment persistence has been suggested as a proxy for real-world therapeutic benefit and harm of treatments for chronic non-curable diseases, including rheumatoid arthritis. We hypothesized that the different pharmacological characteristics of infliximab, adalimumab and etanercept cause statistically and clinically significant differences in persistence.MethodsWe conducted a population-based cohort study using administrative health data from the Canadian province of British Columbia. The study cohort included rheumatoid arthritis patients who initiated the first course of a TNF antagonist between 2001 and 2008. Persistence was measured as the time between first dispensing to discontinuation. Drug discontinuation was defined as a drug-free interval of 180 days or switching to another TNF antagonist, anakinra, rituximab or abatacept. Persistence was estimated and compared using survival analysis.ResultsThe study cohort included 2,923 patients, 63% treated with etanercept. Median persistence in years (95% confidence interval) with infliximab was 3.7 (2.9–4.9), with adalimumab 3.3 (2.6–4.1) and with etanercept 3.8 (3.3–4.3). Similar risk of discontinuation was observed for the three drugs: the hazard ratio (95% confidence interval) was 0.98 (0.85–1.13) comparing infliximab with etanercept, 0.95 (0.78–1.15) comparing infliximab with adalimumab and 1.04 (0.88–1.22) comparing adalimumab with etanercept.ConclusionsSimilar persistence was observed with infliximab, adalimumab and etanercept in rheumatoid arthritis patients during the first 9 years of use. If treatment persistence is a good proxy for the therapeutic benefit and harm of these drugs, then this finding suggests that the three drugs share an overall similar benefit-harm profile in rheumatoid arthritis patients.

Real-world evaluation of TNF-inhibitor utilization in rheumatoid arthritis

“…Patients did not need to complete the 180-day gap before the end of the 12month post-index period to be classified as discontinuing therapy. Use of a 180-day gap is consistent with other published studies [25][26][27][28] and unlike studies with shorter gaps, we did not use days' supply, rather time between prescriptions and administrations.…”

Autoimuniniu artritu sergančių biologine terapija gydomų pacientų stebėjimo duomenys (lietuvos reumatinių ligų biologinės terapijos duomenų bazės duomenys)

“…In the literature proportion of patients remaining on INF is higher (more than 70 % in RA group, over 60 % in AS and PsA patients), although it must be noted, that the treatment dosage was higher (5 mg/kg in spondyloarthropathies) [33,34]. Similar drug survival was observed in RA patients treated with three TNFα blockers in Fisher's and colleague's paper, though our data showed statistically significant differences between BD groups and treatment survival time was shorter [35]. Better survival with ETA compared to ADA was observed in the PsA patients (68.3 % vs. 51.9 %), though better efficacy was observed in INF and ETA groups [36].…”

Persistence with Biologic Agents for the Treatment of Rheumatoid Arthritis in Japan

“…Most studies are either from Europe [7][8][9][10][11][12][13][14][15][16] or North America, [17][18][19][20][21][22][23] while studies in Asian populations are scarce. Apart from two Korean studies, 24,25 one Japanese prospective cohort study was identified that analyzed patients who started biologic treatment with infliximab, etanercept, or tocilizumab.…”