Objectives To investigate the drug survival of anti-tumor necrosis factor (TNF) agents in Korean patients with rheumatoid arthritis (RA) and find potential predictors associated with treatment discontinuation.
Methods This study included 114 RA patients who were treated with anti-TNF agents in a single tertiary center for at least one year from December 2005 to November 2010. Demographic, clinical, laboratory, and treatment-related data, and DAS28 score at the time of initiation of anti-TNF agents were collected, and the cause of discontinuation was also obtained by reviewing patients’ charts. Survival curves were plotted to compare the drug survival between three different anti-TNF agents, and multivariate Cox proportional hazard models were used to assess predictors of treatment discontinuation of anti-TNF therapy.
Results Of the 114 patients, 22 patients received infiliximab, 39 etaneercept, and 48 adalimumab. Over a mean follow-up of 33.8 months (range, 10–77 months), 64patients (56.1%) discontinued their first anti-TNF agents. The mean duration of receiving the first anti-TNF agents was 18.1 months, and 1-year and 4-year drug survival rates were 44% and 37%, respectively. In multivariate Cox proportional hazard analyses, the drug discontinuation rate was differed between the 3 anti-TNF agents (p<0.05). The etanercept group had a lower discontinuation rate compared with the infliximab group (hazard ratio [HR] 0.472, 95% CI 0.230-0.976, p<0.05). The discontinuatoin rate between the adalimumab group and the infliximab group was not different. Patients receiving corticosteroids in combination with anti-TNF agents were more likely to discontinue their anti-TNF therapies (HR 7.850, 95% CI 1.012-60.890, p<0.05). The most common reason for discontinuation of anti-TNF agents was inefficacy (67.2%): 70.6% with etanercept, 64.3% with adalimumab, and 68.4% with infliximab. Other discontinuation causes were infection (5 patients), skin eruption (3 patients), and aggravation of heart failure (1 patient).
Conclusions The drug survival rate of anti-TNF agents was relatively lower in these patients, with etanercept having the best retention rate. The predictor of discontinuation of anti-TNF therapy was the concomitant use of corticosteroids. Our study provides further evidence that the real-life treatment of RA patients may be different from that of randomized clinical trials.
Disclosure of Interest None Declared