Background Real life evidence regarding the effectiveness and discontinuation of golimumab across indications is limited.
Objectives To describe the effectiveness and persistence of golimumab in a real-life setting, in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and other spondyloarthropathies (SpA), in relation to disease activity at treatment initiation.
Methods The national Swedish Rheumatology Quality Register (SRQ) was used to identify patients starting treatment with golimumab between 2009 and 2014. Effectiveness was assessed using the difference between start of treatment and at the 6 months visits (defined as 110–240 days from start of treatment) of different measures of disease activity. Persistence was evaluated using Kaplan Meier curves and Cox proportional hazard model.
Results A total of 2984 patients (1366 RA (69% were RF positive), 655 PsA, 499 AS and 464 SpA) started treatment with golimumab. The percentage of bionaïve patients was similar across indications (from 46% in AS to 48% in RA). There was positive response at 6 months across all indications, according to DAS28, HAQ, tender and swollen joint counts (TJC and SJC), patient global health, pain, EQ-5D, CRP and SR (Table 1). Proportion of persistence was highest in AS (69% at 1 year, 56% at 2, and 50% at 3), and was lowest in PsA (60%, 49%, and 42%). Across all indications, the hazard ratio of discontinuation was higher among women, lower among bionaïve compared to non-bionaïve patients, and 34% higher among RA patients >65 years old compared to RA patients 56–65 years old. There was no association between age and discontinuation among patients with other indications, and between DAS28 and HAQ and discontinuation in RA and SpA.
Conclusions In this real-life national cohort, patients on golimumab experienced clinical improvement. Persistence is dependent on contextual factors rather than disease activity at start, and is better in AS than in RA.
Disclosure of Interest None declared
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