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The effectiveness and medication costs of three anti-TNF agentsα in the treatment of rheumatoid arthritis from prospective clinical practice data
  1. W Kievit (w.kievit{at}
  1. Radboud University Nijmegen Medical Centre, Netherlands
    1. E M Adang (e.adang{at}
    1. Radboud University Nijmegen Medical Centre, Netherlands
      1. J Fransen (j.fransen{at}
      1. Radboud University Nijmegen Medical Centre, Netherlands
        1. H H Kuper (h.kuper{at}
        1. Medisch Spectrum Twente, Netherlands
          1. M AFJ van der Laar (m.vandelaar{at}
          1. Medisch Spectrum Twente, Netherlands
            1. T L Jansen (t.jansen{at}
            1. Medical Centre Leeuwarden, Netherlands
              1. C MA De Gendt (cdegendt{at}
              1. Alysis Care Group, Netherlands
                1. D-J RAM De Rooij (dj.derooij{at}
                1. St Maartenskliniek, Netherlands
                  1. H LM Brus (hbrus{at}
                  1. TweeSteden Hospital, Netherlands
                    1. P CM van Ooijen (p.v.oijen{at}
                    1. Jeroen Bos Hospital, Netherlands
                      1. P CLM van Riel (p.vanriel{at}
                      1. Radboud University Nijmegen Medical Center, Netherlands


                        Purpose: to evaluate the effects of adalimumab, etanercept and infliximab on disease activity, functional ability and quality of life and the medication costs in a naturalistic design.

                        Methods: All patients from the Dutch Rheumatoid Arthritis Monitoring (DREAM) register starting on TNFα-blocking agents for the first time were monitored and assessed by trained research nurses every three months. The primary outcome was the disease activity score (DAS28) course over the 12 months follow-up, analysed by linear mixed models. Secondary outcomes were the Health Assessment Questionnaire (HAQ), EuroQol five dimensions (EQ-5D), the Short-Form 36 items (SF36) and medication related total costs.

                        Results: The DAS28 and SF-36 physical component scale decreased in all three medication groups over 12 months, but the decrease was larger for both adalimumab and etanercept in comparison to infliximab (p<0.0001). The analyses concerning the HAQ and the EQ-5D showed the same (non-significant) trend, namely that at 12 months, the functionality and quality of life was better for adalimumab and etanercept patients. With regard to the medication costs, infliximab treatment resulted in significantly higher costs over the follow-up period than treatments with either adalimumab or etanercept. The comparison between adalimumab and etanercept showed a significant difference in the 12-months DAS28 course (p=0.031). There were no additional indications for differences in effectiveness or costs between adalimumab and etanercept.

                        Conclusion: The evaluation of the effectiveness and costs showed that adalimumab and etanercept are more or less equal and favourable compared to infliximab in the first year of treatment.

                        • anti-TNF&[alpha]
                        • costs
                        • observational study
                        • quality of life
                        • rheumatoid arthritis

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