Background Several factors may lead to discontinuation of biologic therapies by patients with rheumatoid arthritis (RA). The role of these factors in discontinuation of therapy should be examined to determine how best to achieve successful and uninterrupted treatment.
Objectives To examine reasons for discontinuation of subcutaneous (SQ) anti-TNF treatment in the past twelve months from the RA patient perspective.
Methods Data were collected in Spring 2011 using self-reported, internet-based questionnaires. Study inclusion criteria were: RA diagnoses; discontinued a SQ anti-TNF medication (adalimumab, certolizumab, etanercept, or golimumab) within the past 12 months; aged ≥18 years; reside in the United States; consented to participate. Patients reported primary and other reasons for discontinuation. Patients who discontinued more than one SQ anti-TNF in the past 12 months reported on the one most recently discontinued.
Results Completed questionnaires were analyzed for 250 patients. The majority were female (72.8%) and white (80.8%); median age was 51 years. More patients most recently discontinued etanercept (43.6%) or adalimumab (39.2%) than certolizumab (9.6%) or golimumab (7.6%). When prompted about the primary reason for discontinuation, lack of effectiveness (40.8%) was most often cited, followed by injection experience (18.4%). Combining prompted primary and other reasons for discontinuation, 60.8% reported lack of effectiveness and 40.8% reported injection experience. These injection experience reasons included: pain/burning/discomfort after injection (14.4%); pain/burning/discomfort during injection (13.2%); injection reactions such as redness/swelling after injection (12.4%); dislike self injection (11.6%); dislike frequency of injection (10.4%); fearful of injection/needles (6.8%).
Conclusions From the patient perspective, there are remaining unmet needs related to effectiveness and injection experience with SQ anti-TNF medications, which lead to discontinuation. Newer treatment options may address some of these unmet needs. These results demonstrate the importance of including the patient perspective when making treatment decisions.
Disclosure of Interest S. Bolge Employee of: Janssen Scientific Affairs, LLC, A. Goren Consultant for: Janssen Scientific Affairs, LLC, N. Tandon Employee of: Janssen Scientific Affairs, LLC