Background: Tumor necrosis factor inhibitors (TNFi) should be used for the treatment of rheumatoid arthritis (RA) in combination with conventional synthetic disease modifying anti-rheumatic drugs (csDMARD), preferably methotrexate (MTX). However a significant proportion of RA patients receive TNFi in combination with other csDMARD or in monotherapy.
Objectives: To assess the effect of co-medication with MTX or other csDMARDs on drug survival of TNFi treated RA patients.
Methods: All adult patients with RA followed in the Czech national registry ATTRA who started TNFi therapy after January 1st 2012 were considered. Six-year drug survival for patients on TNFi in combination with MTX, with other csDMARD or in monotherapy was analyzed using Kaplan-Meier method, log rank test was used to compare differences between groups. Reasons for TNFi discontinuation were analyzed. ATTRA is a centralized prospective computerized registry of patients receiving biologic disease modifying anti-rheumatic drugs (bDMARD) therapy for rheumatic diseases collecting data on efficacy, safety and quality of life of all patients treated with bDMARDs in the Czech Republic. TNFi therapy is indicated for patients with RA who have failed treatment with at least one csDMARD.
Results: A total of 1841 RA patients initiated first bDMARD treatment during the studied period, with 1724 patients receiving TNFi. 1307 patients (76%) started TNFi therapy in combination with MTX, 267 patients (15%) with other csDMARD and 150 patients (9%) as monotherapy. Overall unadjusted TNFi drug survival was better in patients receiving MTX co-medication (median survival 53 months) compared to those receiving other csDMARD (median survival 36 months) or those being on monotherapy (median survival 21 months; p<0.001 for monotherapy vs MTX co-medication) (Figure). The most common reason for TNFi discontinuation was loss of efficacy (33%, 37% and 28% for MTX, csDMARD combination and monotherapy respectively) followed by primary inefficacy (20%, 19% and 27%) and adverse events (19%, 15%, 23%).
Conclusion: In this registry study of patients with RA, use of MTX co-medication was associated with significantly better first TNFi drug survival compared to other csDMARD co-medication and to monotherapy.
Acknowledgement: This study was supported by the project of MHCR for conceptual development of research organization 00023728
Disclosure of Interests: Heřman Mann Consultant for: Pfizer, Eli Lilly, Sanofi, Speakers bureau: AbbVie, Roche, Pfizer, MSD, Eli Lilly, Sanofi, Lucie Nekvindova: None declared, Jakub Zavada Consultant for: Genzyme-Sanofi, Glaxo, Pfizer, Abbvie, Speakers bureau: Novartis, Sandoz, Biogen, Ladislav Šenolt Grant/research support from: AbbVie, Consultant for: AbbVie, Bristol-Myers Squibb, Celgene Corporation, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Amgen, Takeda, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Pavel Horak Speakers bureau: AbbVie, Roche, Pfizer, MSD, Amgen, Novartis, Eli Lilly, Sanofi.
, Zlatuse Kristkova: None declared, Jiří Vencovský Consultant for: Samsung, Speakers bureau: AbbVie, Novartis, Pfizer, Sanofi, Eli Lilly, Biogen, UCB, MSD, Werfen, Roche, Karel Pavelka: None declared
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