Purpose To compare the effectiveness of anti-tumour necrosis factor (TNF) agents in biologically naive and ‘switched’ rheumatoid arthritis (RA) patients.
Methods RA patients enrolled in the CORRONA registry newly prescribed adalimumab (n=874), etanercept (n=640), or infliximab (n=728) were stratified based on previous anti-TNF use. Clinical effectiveness at 6, 12 and 24 months was examined using the modified American College of Rheumatology response criteria (mACR20/50/70) and achievement of remission (28-joint disease activity score (DAS28) and clinical disease activity index (CDAI)) in unadjusted and adjusted analyses. The persistence of anti-TNF treatment was examined using Cox proportional hazard models.
Results Among 2242 patients (1475 biologically naive, 767 switchers), mACR20, 50 and 70 responses were similar (p>0.05) for adalimumab, etanercept and infliximab at all time points, as were rates of CDAI and DAS28 remission (p>0.05). Response and remission outcomes were consistently inferior for switched versus biologically naive patients. The adjusted OR for achieving an mACR20 response was 0.54 (95% CI 0.38 to 0.76) in first-time switchers and 0.42 (95% CI 0.23 to 0.78) in second-time switchers versus biologically naive patients at 6 months. The adjusted OR for achieving DAS28 remission were 0.29 (95% CI 0.15 to 0.58) for first-time switchers and 0.26 (95% CI 0.08 to 0.84) for second-time switchers. Persistence was higher in biologically naive patients, for whom persistence was highest with infliximab.
Conclusions No differences in rates of drug response or remission were observed among the three anti-TNF. Infliximab was associated with greater persistence in biologically naive patients. Response, remission and persistence outcomes were diminished for patients who switched anti-TNF.
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Funding Within the previous 2 years, Abbott, Amgen, BMS, Centocor, Genentech, Lilly and Roche have supported CORRONA through contracted subscriptions to the database. Centocor, as part of its subscription contract, proposed the current research study and was involved in the early design, as well as manuscript review and comment for this study. The final analysis plan, the study results and interpretations of the study data were those of the non-Centocor authors. The manuscript was written by the first author with content and editorial input from all co-authors.
Competing interests JG receives salary support from research grants from the National Institutes of Health (NIH) (K23AR054412), the Arthritis Foundation and the Arthritis National Research Foundation. He serves as chief scientific officer for CORRONA and has served on advisory boards for Centocor, Genentech, and UCB. GR has a research contract with CORRONA. DD is an employee of Janssen Services LLC. LH was supported by grant no K23AR053856 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. DF receives funding from Abbott, Actelion, Amgen, BMS, BiogenIdec, Centocor, Corrona, Genentech, Gilead, GSK, Human Genome Sciences, Merck, NIH, Nitec, Novartis, Roche, UCB, Wyeth and Xoma. He also serves as director of publications for CORRONA. AG is executive vice president of CORRONA. He is a consultant to Abbott, Amgen, Nicox, Pfizer, Roche, Savient, Takeida and UCB. He is a speaker for Abbott, Amgen, BMS, Pfizer and Roche. In addition, he and/or his spouse are stockholders in Abbott, Amgen, BMS, J&J and Pfizer. RDH is an employee of Centocor Ortho Biotech Services LLP. MK has no competing interests. JMK receives research support from Amgen, Abbott, Centocor, BMS, Genentech, HGS, Pfizer, Roche and UCB as well as honoraria from Abbott, Centocor, BMS, Roche and Genentech.
Ethics approval Approvals for data collection and analyses were obtained for academic and private practice sites from local and central institutional review boards, respectively.
Provenance and peer review Not commissioned; externally peer reviewed.