Background To date four subcoutaneus TNF inhibitors (TNFis) have been licensed for the treatment of rheumatoid arthritis (RA). Although data from real-life registries have largely confirmed the favourable long term retention rates of adalimumab (ADA) and etanercept (ETN), data on golimumab (GOL) and certolizumab pegol (CZP) drug survival are still lacking.
Objectives The aim of the study is to evaluate the 2-year retention rate of TNFis used as 1st or 2nd line biotherapy in RA patients in a multicentric observational cohort (the LORHEN registry).
Methods Data of all RA patients treated with a TNFi were retrospectively extracted from the LORHEN registry, including a cohort of more than 3000 RA subjects who received at least one biologic agent since 1999. The analysis was limited to patients who received ADA, ETN, CZP, or GOL as first- or second-line biotherapy in the period when all the considered TNFis were available in Italy (from January 2010 to November 2015). The 2-year retention rate was calculated by Kaplan-Meier method and the comparative risk for discontinuation among individual TNFi was compared by a stratified log-rank test. Sub-analyses according to first or second line treatment have been performed.
Results The study population included 677 RA patients (79.7% female, mean age [±SD] 54.3 [±13.5] years, mean disease duration 8.9 [±8.8] years, mean baseline disease activity score 28 4.9 [±1.3]), treated with a first (n=444) or a second line (n=233) TNFi. In the biologic naïve group, 141 patients received ADA, 88 CZP, 130 ETN, and 85 GOL, whereas in the switcher group 68 patients have been treated with ADA, 38 with CZP, 76 with ETN, and 51 with GOL. The overall 2-year retention rate was 58.5% (63.3 and 49.4% in first- and second-line group, respectively; p<0.001). The 2-year drug survival of individual TNFi was 46% for ADA, 66% for CZP, 56% for ETN, and 53% for GOL (p=0.006 for CZP vs ADA, p=n.s. for other comparisons). Sub-analyses according to line of TNFi treatment demonstrated 2-year retention rate of ADA, ETN, CZP, and GOL to be 57.4, 66.9, 73.9, and 56.5%, respectively (p=0.048 for CZP vs ADA, p=n.s for other comparisons) in biologic naïve patients and 38.2, 46.1, 60.5, and 60.8%, respectively (p=0.017 for GOL vs ADA, p=n.s for other comparisons) in switchers.
Conclusions In the real-life scenario of the Lorhen registry, overall 2-year retention rate of TNFis was about 60% with a significantly higher persistence in biologic naïve patients compared with switchers. In the comparison among individual TNFis, no significant differences were found with the exception of a lower drug survival of ADA compared with CZP in biologic naïve subjects and with GOL in switchers.
Disclosure of Interest None declared
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