Comparison of drug retention rates and causes of drug discontinuation between anti–tumor necrosis factor agents in rheumatoid arthritis

Authors

  • Sophie Martin Du Pan,

    Corresponding author
    1. Geneva University Hospital, Geneva, Switzerland
    • Division of Rheumatology, Department of Internal Medicine, University Hospital of Geneva, 26 Avenue Beau-Sejour, 1211 Geneva 14, Switzerland
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  • Silvia Dehler,

    1. Swiss Clinical Quality Management Foundation and University of Zurich, Zurich, Switzerland
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  • Adrian Ciurea,

    1. University Hospital, Zurich, Switzerland
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    • Dr. Ciurea has received speaking fees (less than $10,000 each) from Enex, Roche, Wyeth, and Abbott.

  • Hans-Rudolf Ziswiler,

    1. University Hospital Berne, Berne, Switzerland
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    • Dr. Ziswiler has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Pfizer and Abbott.

  • Cem Gabay,

    1. Geneva University Hospital, Geneva, Switzerland
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    • Dr. Gabay has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Roche, Abbott, Wyeth, BMS, and Merck-Sorono.

  • Axel Finckh

    1. Geneva University Hospital, Geneva, Switzerland
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    • Dr. Finckh has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from BMS, Abbott, and Wyeth, and (more than $10,000) from Roche.


Abstract

Objective

Tumor necrosis factor (TNF) inhibitors have revolutionized the treatment of severe rheumatoid arthritis (RA), yet drug discontinuation is common. The aim of this study was to compare treatment retention rates and specific causes of anti-TNF discontinuation in a population-based RA cohort.

Methods

All patients treated with etanercept, infliximab, or adalimumab within the Swiss Clinical Quality Management RA cohort between 1997 and 2006 were included in the study. Causes of treatment discontinuation were broadly categorized as adverse events (AEs) or nontoxic causes, and further subdivided into specific categories. Specific causes of treatment interruption were analyzed using a Cox proportional hazards model and adjusted for potential confounders.

Results

A total of 2,364 anti-TNF treatment courses met the inclusion criteria. Treatment discontinuation was reported 803 times: 309 with etanercept, 249 with infliximab, and 245 with adalimumab. Drug inefficacy represented the largest single cause of treatment discontinuation (55.8% of cases). The median time of receiving anti-TNF therapy was 37 months, but discontinuation rates differed between the 3 anti-TNF agents (P < 0.001), with shorter retention rates for infliximab (hazard ratio [HR] 1.24, 99% confidence interval [99% CI] 1.01–1.51). The specific causes of treatment discontinuation revealed an increased risk of AEs with infliximab (HR 1.4, 99% CI 1.003–1.96), mostly due to an increased risk of infusion or allergic reactions (HR 2.11, 99% CI 1.23–3.62). Other discontinuation causes were equally distributed between the anti-TNF agents.

Conclusion

In this population, infliximab was associated with higher overall discontinuation rates compared with etanercept and adalimumab, which is mainly due to an increased risk of infusion or allergic reactions.

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