Drug Survival Rates of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis

Abstract

We investigated the compliance of Korean patients using tumor necrosis factor (TNF) inhibitors to treat rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation. The study population comprised 114 RA and 310 AS patients treated with TNF inhibitors at a single tertiary center for at least 1 yr from December 2002 to November 2011. Of the 114 RA patients, 64 (56.1%) discontinued their first TNF inhibitors with a mean duration of 18.1 months. By contrast, 65 of 310 patients (21.0%) with AS discontinued their first TNF inhibitors, with a mean duration of 84 months. Although the survival rate did not differ among the three TNF inhibitors in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. In addition, RA patients who received corticosteroids in combination with TNF inhibitors were more likely to discontinue their TNF inhibitors. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials.Graphical Abstract

Profiling Response to Tumor Necrosis Factor Inhibitor Treatment in Axial Spondyloarthritis

“…However, patients may stop or switch their medications because of inefficacy, adverse reactions, and other issues such as insurance‐related problems. Lack of response to TNFi ranges between 30% and 55% of AS patients . In our study, among patients treated mainly for axial disease, 37% of the patients needed to stop or switch their TNFi because of treatment failure.…”

Treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis

“…Despite the benefits anti-TNF drugs have in the control of both diseases 14 , 17 , some patients experience therapeutic failure or go by adverse events and end up interrupting their therapies 10 . However, no studies have been conducted so far to analyze the use of these medications in the context of SUS.…”

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

“…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. 26 The authors found significant differences in demography, clinical status, comorbidities, and usage of concomitant drugs among the three drugs.…”

“…24,40 The regression results give rise to evidence (limited to the continuing population) that comorbidities increased the probability of treatment discontinuation, which is in line with international results. 21 Other studies, however, found that the CCI does not affect persistence, 9,25 and the indication of peptic ulcer disease even had a positive effect on persistence of tumor necrosis factor inhibitors. 25 According to our estimates, the elderly seem to be more persistent than younger patients.…”

“…21 Other studies, however, found that the CCI does not affect persistence, 9,25 and the indication of peptic ulcer disease even had a positive effect on persistence of tumor necrosis factor inhibitors. 25 According to our estimates, the elderly seem to be more persistent than younger patients. That elderly patients are more persistent is a well-established result both in RA 8,40 and many other indications.…”