Retention rates of adalimumab, etanercept and infliximab as first and second-line biotherapy in patients with rheumatoid arthritis in daily practice

• Published in: Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2014-07, Vol.81 (4), p.352-359
• Main Authors: Frazier-Mironer, Aline, Dougados, Maxime, Mariette, Xavier, Cantagrel, Alain, Deschamps, Véronique, Flipo, René Marc, Logeart, Isabelle, Schaeverbeke, Thierry, Sibilia, Jean, Le Loët, Xavier, Combe, Bernard
• Format: Article
• Language: English
• Subjects: Adalimumab; Adult; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Etanercept; Female; Humans; Immunoglobulin G - therapeutic use; Infliximab; Internal Medicine; Male; Middle Aged; Receptors, Tumor Necrosis Factor - therapeutic use; Retention rate; Retrospective Studies; Rheumatoid arthritis; Rheumatology; TNF-α inhibitors
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2014.02.014

Abstract Objectives To compare retention rates of adalimumab, etanercept and infliximab as first-line biotherapy in rheumatoid arthritis (RA), to determine causes of discontinuation, retention-associated factors, and retention rates of possible second-line TNF-α inhibitors (TNFi). Methods In this retrolective, multicentric study, medical charts of RA patients starting TNFi between March 2005 and April 2009 were reviewed, with follow-up between two and six years. The retention rate was estimated using the Kaplan-Meier method. Comparison between TNFi was done after adjustment using a Cox model. Factors associated with better retention were identified by multivariate analysis. Results Of the 706 patients included, the percentage continuing treatment after two years was 54.9, 61.9 and 48.7%, and the median retention was 31, 45 and 23 months for adalimumab, etanercept and infliximab, respectively. The hazard ratios (HRs) for discontinuation were greater with adalimumab and infliximab than etanercept (1.315, 95% CI [1.050–1.648] and 1.380, 95% CI [1.041–1.828], respectively). The HR for discontinuation due to inefficacy was significantly higher with adalimumab than etanercept. Adverse events were significantly higher with infliximab than etanercept. Past use of more DMARDs and higher baseline ESR were associated with better retention. The median retention of the second-line TNFi was 11, 43 and 19.1 months for adalimumab, etanercept, and infliximab, respectively. HRs for adalimumab discontinuation due to all causes were significantly greater than for etanercept. Conclusions Etanercept had a better retention rate than adalimumab and infliximab as first-line biotherapy in RA, and than adalimumab as second-line biotherapy.