Objectives To compare radiographic progression during treatment with disease-modifying antirheumatic drugs (DMARD) and subsequent treatment with tumour necrosis factor α inhibitors (TNF-I) in rheumatoid arthritis (RA) patients in clinical practice.
Methods Conventional radiographs (x-rays) of hands and wrists were obtained ∼2 years before start (prebaseline), at baseline and ∼2 years after start (follow-up) of TNF-I. Clinical data were obtained from the DANBIO registry and the patient files. x-Rays were scored blinded to chronology according to the Sharp/van der Heijde method. Annual radiographic progression rates during the DMARD (prebaseline to baseline x-ray) and TNF-I (baseline to follow-up x-ray) periods were calculated.
Results 517 RA patients (76% women, 80% IgM rheumatoid factor positive, 65% anticyclic citrullinated peptide positive, 40% current smokers, age 54 years (range 21–86), median disease duration 5 years (range 0–57)) were included. Patients were treated with infliximab (61%), etanercept (15%) or adalimumab (24%). During the DMARD period 85% of patients received methotrexate, 51% sulphasalazine and 78% prednisolone. The median DMARD period was 733 days (IQR 484–1002) and the median TNF-I period was 562 days (IQR 405–766). The median radiographic progression rate decreased from 0.7 (IQR 0–2.9) total Sharp score units/year (dTSS) in the DMARD period to 0 (0–0.9) units/year in the TNF-I period (p<0.0001, Wilcoxon). Corresponding mean dTSS values were 2.1 (SD 3.7) versus 0.7 (SD 2.3) units/year (p<0.0001, paired t test). 305 patients progressed (dTSS >0) in the DMARD period compared with 158 patients in the TNF-I period (p<0.0001, χ2).
Conclusion This nationwide observational study of RA patients documented significantly reduced radiographic progression during TNF-I treatment compared with the previous period of DMARD treatment.
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Funding Danish Regions (ie, the hospital owners) gave financial support to DANBIO. Janssen Biologics (formerly Centocor) supported the present study with an unrestricted grant, while Abbott, Pfizer (formerly Wyeth) and MSD (formerly Schering-Plough) (since 2004), Bristol-Myers Squibb and Roche (since 2006), and UCB-Nordic (since 2007) have supported DANBIO with unrestricted grants. Janssen Biologics were allowed to comment on the work, but the authors had the full right to accept or refuse these comments. Except for this, the sponsors have had no influence on data collection, analysis or publication.
Competing interests MØ has received consulting fees, speaking fees or research grants from Abbott, Amgen, Bristol-Myers Squibb, Centocor/Janssen, Genmab, Glaxo-Smith-Kline, Mundipharma, Novo, Pfizer, Roche, Schering-Plough, UCB and Wyeth. UT has received consulting fees, speaking fees or research grants from Roche, Schering-Plough, Abbott and MSD. GK has received consulting fees, speaking fees or research grants from MSD. ORM has received consulting fees, speaking fees and research grants from Abbott, MSD, Pfizer, UCB, BMS, Amgen and Roche. HL has received consulting fees, speaking fees or research grants from Roche. AH has received consulting fees, speaking fees or research grants from Abbott, MSD and BMS. MLH has received consulting fees, speaking fees or research grants from Abbott, Bristol-Myers Squibb, Centocor/Janssen, Glaxo-Smith-Kline, MSD/Schering-Plough, Pfizer/Wyeth, Roche and UCB The remaining authors had no completing interests.
Ethics approval The study was based on data from the nationwide Danish DANBIO registry. DANBIO has been approved by The Danish Data Registry since the year 2000 (j.nr. 2007-58-0014 and j.nr. 2007-58-0006), and since October 2006 as a national quality registry by the National Board of Health (j.nr. 7-201-03-12/1). According to Danish law, informed consent and ethics approval were not required for the present study.
Provenance and peer review Not commissioned; externally peer reviewed.