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Do changes in prescription practice in patients with rheumatoid arthritis treated with biological agents affect treatment response and adherence to therapy? Results from the nationwide Danish DANBIO Registry
  1. M L Hetland1,
  2. H M Lindegaard2,
  3. A Hansen3,
  4. J Pødenphant3,
  5. J Unkerskov4,
  6. V S Ringsdal5,
  7. M Østergaard1,3,
  8. U Tarp6
  1. 1
    DANBIO Registry and Copenhagen University Hospital, Department of Rheumatology, Hvidovre Hospital, Denmark
  2. 2
    Department of Rheumatology, Odense University Hospital, Denmark
  3. 3
    Copenhagen University, Department of Rheumatology, Herlev Hospital, Denmark
  4. 4
    Institute for Rational Pharmacotherapy, Danish Medicines Agency, Denmark
  5. 5
    Aarhus University, Department of Rheumatology, Aalborg Hospital, Denmark
  6. 6
    Aarhus University, Department of Rheumatology, Aarhus Hospital, Denmark
  1. Dr M L Hetland, DANBIO, Department of Rheumatology, Hvidovre Hospital, Kettegård Alle 30, DK 2650, Hvidovre, Denmark; merete.hetland{at}


Background: Prescription practice for tumour necrosis factor α (TNFα) inhibitors has changed towards treating patients with lower disease activity.

Objective: To determine the trend in treatment response in cohorts of patients with rheumatoid arthritis who started TNFα inhibitor treatment between 2000 and 2005.

Methods: 1813 patients with RA starting treatment with biological agents in 2000–5 were registered prospectively in the nationwide DANBIO Registry. Baseline disease activity and 12 months’ treatment responses were determined in cohorts based on start year (2000/1; 2002; 2003; 2004; 2005).

Results: Despite decreasing baseline disease activity from the 2000/2001 cohort to 2005 cohort (28-joint count Disease Activity Score (DAS28): from 5.9 to 5.3 (p<0.001)), the 12 months’ DAS improvement increased from 1.8 units (2000/2001 cohort) to 2.2 units (2005 cohort) (p<0.001). The fraction with good EULAR response increased from 28% (2000/2001 cohort) to 50% (2005 cohort); the fraction with no response decreased from 29% (2000/2001 cohort) to 16% (2005 cohort). ACR20/50/70 response rates increased from 53%/31%/13% (2000/2001 cohort) to 69%/51%/30% (2005 cohort). After correction for withdrawals, treatment responses were lower, but patterns unchanged. One-year drug survival was for the 2000/2001 cohort: 73%, 2002: 62%, 2003: 67%, 2004: 70%, 2005: 69%.

Conclusion: From 2000 to 2005, significantly improved treatment responses to TNF inhibitors were seen in clinical practice despite decreasing baseline disease activity levels. This lends support to the less stringent prescription practice towards treating patients with lower disease activity that has been observed in several countries.

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  • Competing interests: MLH has received consulting fees, speaking fees or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic and Wyeth, and she has received grants from Abbott, Bristol-Myers Squibb, Roche, Schering-Plough, UCB-Nordic and Wyeth on behalf of DANBIO. HML has received consulting fees from Roche. AH has received consultant fees or speaking fees from Abbott and Schering-Plough. JP has received consultant fees or speaking fees from Wyeth, Abbott and Bristol-Myers Squibb. JU has nothing to declare. VSR has received consulting or speaking fees from Abbott, Schering-Plough and Wyeth. MØ has received consulting fees, speaking fees or research grants from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genmab, Glaxo-Smith-Kline, Pfizer, Roche, Schering-Plough and Wyeth. UT has received consulting or speaking fees from Abbott, Genmab, Schering-Plough and Wyeth.

  • Funding: DANBIO is indebted to the head of the Institute for Rational Pharmacotherapy, Jens Peter Kampmann, who hosted and financed the database from 2000 to 2003. Abbott, Wyeth and Schering-Plough (since 2004), Bristol-Myers Squibb and Roche (since 2006), and UCB-Nordic (since 2007) have sponsored DANBIO with unrestricted grants. Danish Regions gave financial support to the activities related to quality improvement of biological treatment. The principal author received a grant from the Danish Rheumatism Association and the Margarethe Astrid Hedvig Schaufuss Legat.

  • All departments of rheumatology in Denmark are listed in the appendix.