Comparative effectiveness and survival of infliximab,adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival |
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| Authors: | Irini Flouri Theodora E. Markatseli Paraskevi V. Voulgari Kyriaki A. Boki Ioannis Papadopoulos Loukas Settas Dimitrios Zisopoulos Fotini N. Skopouli Alexios Iliopoulos George K. Bertsias Pierre Geborek Alexandros A. Drosos Dimitrios T. Boumpas Prodromos Sidiropoulos |
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| Affiliation: | 1. Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece;2. Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece;3. Rheumatology Department, Sismanoglio Hospital, Athens, Greece;4. Rheumatology Clinic, General Hospital of Kavala, Greece;5. First Department of Internal Medicine, Rheumatology Section, AHEPA Hospital of the Aristotle University Medical School, Thessaloniki, Greece;6. Department of Rheumatology, 424 General Army Hospital, Thessaloniki, Greece;g Department of Nutrition and Diebetics, Harokopio University, Athens, Greece;h Department of Rheumatology, Veterans Administration Hospital, Athens, Greece;i Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden;j Faculty of Medicine, National and Kapodestrian University of Athens, Athens, Greece |
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| Abstract: | ObjectiveTo compare effectiveness, drug survival, and safety between infliximab, adalimumab, and etanercept, in a nationwide cohort of rheumatoid arthritis (RA) patients.MethodsThis study is a prospective cohort study of 1208 active RA patients. Effectiveness, drug survival, and serious adverse events during entire follow-up (median 2.9 years) were monitored.ResultsEULAR and CDAI responses were comparable between the three agents (EULAR good/moderate responses at 12 months ranged 76–79%). At 12 months, 15–23% achieved remission. For adalimumab and etanercept, adjusted hazard rate (HR) for EULAR/ACR remission (reference: infliximab) was 2.7 and 2.1 (95% confidence interval was 1.7–4.1 and 1.3–3.4, respectively); males (HR 1.6; 1.1–2.4), use of glucocorticoids (HR 2.0; 1.3–3.0), and swollen joint count >7 (HR 0.36; 0.24–0.55) were independent predictors. Five-year drug survival was 31%, 43%, and 49% for infliximab, adalimumab, and etanercept, respectively (p = 0.010). Infliximab was associated with significantly more withdrawals due to adverse events. Disease activity, CRP, and use of glucocorticoids predicted efficacy-related drug survival; age, use of methotrexate, and prior DMARDs failures predicted safety-related survival. Risk for serious infections was lower with adalimumab (odds ratio [OR] 0.62; 0.38–1.00) or etanercept (OR 0.39; 0.21–0.72) than infliximab, independent of the effects of age (OR 1.65; 1.37–2.00 per 10 years), tender joint count >10 (OR 1.86; 1.21–2.86), and glucocorticoids >35 mg/week (OR 1.83; 1.12–2.99).ConclusionsResponse rates were comparable among anti-TNF agents. Overall, 5-year drug survival was below 50%, with infliximab demonstrating increased safety-related discontinuations. Remission rates are low in clinical practice. Strategies to increase effectiveness and long-term survival of anti-TNF agents in RA are needed. |
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| Keywords: | Arthritis Biological therapies Efficacy Safety Infections Glucocorticoids Registry |
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