Background Drug survival in real clinical practice is reflecting both efficacy and safety of the drug. It is valuable outcome measure complementary to data from RCT.
Objectives To evaluate 10 years efficacy and survival of adalimumab (ADA) in Czech registry ATTRA. To analyse reasons for drug discontinuation and analyse baseline demographic and clinical characteristics predictive for drug discontinuation. We also aimed to compare survival of ADA between 3 different diagnosis (RA, AS, SpA). Finally we aimed to compare survival between different anti TNF drugs.
Methods All patients fulfilled criteria of Czech Rheum. Soc. for indication of anti TNF therapy and were included in registry. They were followed each 3 month first year and than each 6 month. The main outcome measures in RA were DAS 28, HAQ, EuroQuol, SF36, CRP, in AS BASDAI, HAQ and ASDAS. Reasons for drug discontinuation were reported as primary failure, secondary failure, adverse advent, remission and others. Statistics – survival on therapy was estimated by Kaplan-Meier analysis. The search for outcome predictors was performed by log-rank test (continuous predictors were appropriately categorized).
Results Altogether 3159 patients with RA, 1785 with AS and 723 with PsA were included.
1598 patients with RA were treated with adalimumab and retention was 75,8 % in one year, 43,8 % in 5 years and 27,7 % in 10 years. The reasons for drug discontinuation were: primary failure 24,9 %, secondary failure 30,5 %, and adverse events (19,8 %)
Predictive factors for adalimumab retention in rheumatoid arthritis were: younger age < 50 years, failure of ≤ 1 csDMARDs in past, combination therapy with csDMARDs at baseline. Sex, RF and anti CCP were not predictive. Drug retention was longest in AS (median 99,6 m), than PsA (median 62,5 m) and shortest in RA (median 43,9 m) (graph 1). Drug survival in rheumatoid arthritis was longer on etanercept than on infliximab (p < 0,001), longer on adalimumab than infliximab (p < 0,001) and equal between adalimumab and etanercept (p = 0,85).
Conclusions Adalimumab retention in registry ATTRA was comparable to other European registries. Predictors of drug retention in RA were: younger age (< 50 years), ≤ 1 csDMARDs in past and in combination with csDMARDs. Survival on adalimumab was longer in AS, than PsA and RA and the same was true for all three anti TNF drugs. Survival on drug in rheumatoid arthritis was longer in adalimumab and etanercept compared to infliximab.
References Key words: biologic therapy, registry ATTRA
Disclosure of Interest None declared
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