Background: The therapy with TNF-α inhibitors is a well-established treatment of RA patients refractory to methotrexate. However, the long-term efficacy of TNF-α blocking in standard care is poorly known. Objectives: To evaluate the 4 years survival of three TNF-α inhibitors, adalimumab, etanercept, and infliximab, in patients with longstanding rheumatoid arthritis (RA) in an Italian national register. Methods: Clinical records of 853 adult patients with RA included in the GISEA (Gruppo Italiano Studio Early Arthritis) register were prospectively analyzed. First endpoint of this study was to assess the difference in drug survival among adalimumab, etanercept, infliximab over 4 years time follow-up. Moreover, the baseline factors that can predict the adherence to the therapy were evaluated. Results: Between 2003-2004, 324 patients were started on treatment with adalimumab, 311 patients with etanercept, and 218 patients with infliximab. At baseline, no significant differences among the three cohorts in terms of age, disease duration, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, patient Health Assessment Questionnaire (HAQ), and disease activity score (DAS28) were found. After 4 years, the global retention rate of anti-TNF-α therapy was 42%. The etanercept survival was 51,4% and was significantly higher than infliximab (37.6%) or adalimumab (36.4%) survival (p<0.0001). Use of concomitant DMARDs, mainly methotrexate, and the presence of comorbidities significantly predicted the drug continuation (p<0.001), while high value of DAS28 and the long disease duration prior to start of TNF-α inhibitors did not. Conclusions: This study supports the evidence that RA patients in the real life may differ from those in clinical randomised clinical trials. The global drug survival of adalimumab, etanercept and infliximab was quite low at four years follow-up while etanercept had the best retention rate. Furthermore, positive strong predictors of adherence to anti-TNF-α therapy were the concomitant use of methotrexate and the presence of comorbidities at baseline, while the severity and the duration of the disease did not affect the risk of discontinuation of TNF-α inhibitors.
Long-term survival of anti-TNF therapy in a large italian cohort of rheumatoid arthritis patients: comparison among adalimumab, etanercept, and infliximab
Gremese E;
2011-01-01
Abstract
Background: The therapy with TNF-α inhibitors is a well-established treatment of RA patients refractory to methotrexate. However, the long-term efficacy of TNF-α blocking in standard care is poorly known. Objectives: To evaluate the 4 years survival of three TNF-α inhibitors, adalimumab, etanercept, and infliximab, in patients with longstanding rheumatoid arthritis (RA) in an Italian national register. Methods: Clinical records of 853 adult patients with RA included in the GISEA (Gruppo Italiano Studio Early Arthritis) register were prospectively analyzed. First endpoint of this study was to assess the difference in drug survival among adalimumab, etanercept, infliximab over 4 years time follow-up. Moreover, the baseline factors that can predict the adherence to the therapy were evaluated. Results: Between 2003-2004, 324 patients were started on treatment with adalimumab, 311 patients with etanercept, and 218 patients with infliximab. At baseline, no significant differences among the three cohorts in terms of age, disease duration, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, patient Health Assessment Questionnaire (HAQ), and disease activity score (DAS28) were found. After 4 years, the global retention rate of anti-TNF-α therapy was 42%. The etanercept survival was 51,4% and was significantly higher than infliximab (37.6%) or adalimumab (36.4%) survival (p<0.0001). Use of concomitant DMARDs, mainly methotrexate, and the presence of comorbidities significantly predicted the drug continuation (p<0.001), while high value of DAS28 and the long disease duration prior to start of TNF-α inhibitors did not. Conclusions: This study supports the evidence that RA patients in the real life may differ from those in clinical randomised clinical trials. The global drug survival of adalimumab, etanercept and infliximab was quite low at four years follow-up while etanercept had the best retention rate. Furthermore, positive strong predictors of adherence to anti-TNF-α therapy were the concomitant use of methotrexate and the presence of comorbidities at baseline, while the severity and the duration of the disease did not affect the risk of discontinuation of TNF-α inhibitors.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
