Funding sources The cost of the DERMBIO database maintenance is covered by unrestricted grants of equal size from the manufacturers of biologic agents [Abbott, Janssen-Cilag, Merck-Serono (2007–2009), MSD, Pfizer] but the sponsors have no influence on data collection, analysis or interpretation of the data and have no access to the data.
Comparison of drug survival rates for adalimumab, etanercept and infliximab in patients with psoriasis vulgaris
Version of Record online: 11 APR 2011
© 2011 The Authors. BJD © 2011 British Association of Dermatologists
British Journal of Dermatology
Volume 164, Issue 5, pages 1091–1096, May 2011
How to Cite
Gniadecki, R., Kragballe, K., Dam, T.N. and Skov, L. (2011), Comparison of drug survival rates for adalimumab, etanercept and infliximab in patients with psoriasis vulgaris. British Journal of Dermatology, 164: 1091–1096. doi: 10.1111/j.1365-2133.2011.10213.x
Conflicts of interest R.G. has obtained research grants from Abbott and lecture fees from Abbott, Janssen-Cilag, MSD and Pfizer. K.K. is consultant and/or speaker for Abbott, Basilea, Janssen-Cilag, LeoPharma, MSD, Novo Nordisk and Pfizer. T.N.D. is consultant and/or speaker for Abbott, Janssen-Cilag, MSD, LeoPharma, Novo Nordisk and Pfizer. L.S. is consultant and/or speaker for Abbott, Janssen-Cilag, MSD, LeoPharma and Pfizer.
- Issue online: 26 APR 2011
- Version of Record online: 11 APR 2011
- Accepted manuscript online: 11 JAN 2011 12:38AM EST
- Accepted for publication 29 December 2010
Background Adherence to treatment is an indicator of treatment success. Long-term data on adherence to biologic treatment in psoriasis are lacking.
Objectives To compare the tumour necrosis factor (TNF)-α inhibitors regarding drug survival rate and safety in patients with psoriasis.
Methods This study is based on data from the Danish nationwide database DERMBIO covering patients with psoriasis treated with a biologic agent. All patients who received anti-TNF-α treatment in academic referral centres were included. Baseline data, adverse events, time on treatment and reason for stopping treatment were recorded. Hazard ratios (HRs) for factors determining drug survival were calculated by logistic regression.
Results In total, 882 treatment series with etanercept (n = 311), adalimumab (n = 427) or infliximab (n = 144) were administered to 747 patients. Significant predictors of drug survival were: sex, the anti-TNF-α agent and the previous response to an anti-TNF-α agent. In the group of anti-TNF-α-naïve patients the longest drug survival was observed for infliximab, followed by adalimumab [HR vs. infliximab 3·70, 95% confidence interval (CI) 1·99–6·89] and etanercept (HR vs. infliximab 3·18, 95% CI 1·72–5·86). The 4-year drug survival is in the range of 40% for etanercept or adalimumab vs. 70% for infliximab. There was no difference in number of adverse events.
Conclusions The overall efficacy of anti-TNF-α drugs diminishes with time, as envisaged by the progressive loss of patient adherence to treatment. The major reasons for stopping treatment were loss of efficacy, followed by adverse events. Infliximab had the best patient retention ability, with 70% of patients still being on the drug after 4 years of treatment.