Switching TNF antagonists in patients with chronic arthritis: an observational study of 488 patients over a four-year period - PubMed (original) (raw)

Switching TNF antagonists in patients with chronic arthritis: an observational study of 488 patients over a four-year period

Juan J Gomez-Reino et al. Arthritis Res Ther. 2006.

Abstract

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications.

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Figures

Figure 1

Figure 1

Survival curve of tumor necrosis factor (TNF) antagonists in BIOBADASER during the first two years of use, ranked by order of treatment. The numbers under the curves represent the patients known to be still on treatment by the end of the interval. Differences in the number between intervals do not mean that patients failed (stopped TNF antagonist). They actually represent the patients known to be still on treatment as of the time marked.

Figure 2

Figure 2

Survival of the second tumor necrosis factor (TNF) antagonist depending on the reason of replacement of first treatment. The numbers under the curves represent the patients known to be still on treatment by the end of the interval. Differences in the number between intervals do not mean that patients failed (stopped TNF antagonist). They actually represent the patients known to be still on treatment as of the time marked. AE, adverse effect.

Figure 3

Figure 3

Survival estimates of infliximab before and after the marketing authorization of etanercept (p < 0.001).

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References

    1. Breedveld FC, Kalden JR. Appropriate and effective management of rheumatoid arthritis. Ann Rheum Dis. 2004;63:627–633. doi: 10.1136/ard.2003.011395. - DOI - PMC - PubMed
    1. Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, Lipsky P. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet. 1999;354:1932–1939. doi: 10.1016/S0140-6736(99)05246-0. - DOI - PubMed
    1. Weinblatt ME, Kremer JM, Bankhurst AD, Bulpitt KJ, Fleischmann RM, Fox RI, Jackson CG, Lange M, Burge DJ. A trial of etanercept, a recombinant tumor necrosis factor receptor:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med. 1999;340:253–259. doi: 10.1056/NEJM199901283400401. - DOI - PubMed
    1. den Broeder A, van de Putte L, Rau R, Schattenkirchner M, Van Riel P, Sander O, Binder C, Fenner H, Bankmann Y, Velagapudi R, et al. A single dose, placebo controlled study of the fully human anti-tumor necrosis factor-alpha antibody adalimumab (D2E7) in patients with rheumatoid arthritis. J Rheumatol. 2002;29:2288–2298. - PubMed
    1. Emery P, Reginster JY, Appelboom T, Breedveld F, Edelmann E, Kekow J, Malaise M, Mola EM, Montecucco C, Sanda M, et al. WHO Collaborating Center consensus on anti-cytokine therapy in rheumatoid arthritis. Rheumatology. 2001;40:699–702. doi: 10.1093/rheumatology/40.6.699. - DOI - PubMed

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