Reasons for Discontinuation and Adverse Effects of TNFα Inhibitors in a Cohort of Patients With Rheumatoid Arthritis and Ankylosing Spondylitis

• Published in: The Annals of pharmacotherapy 2017-05, Vol.51 (5), p.388-393
• Main Authors: García-Lagunar, María Henar, Gutiérrez-Cívicos, María Rocío, García-Simón, María Sergia, Conesa-Zamora, Pablo, Jimenez-Santos, Enrique, Cano-Vivar, Pedro, García-Márquez, Andrés, Muñoz-García, Iris, Viney, Alice Charlotte
• Format: Article
• Language: English
• Subjects: Adalimumab - administration & dosage; Adalimumab - adverse effects; Adalimumab - therapeutic use; Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Drug Utilization - trends; Drug-Related Side Effects and Adverse Reactions - etiology; Etanercept - administration & dosage; Etanercept - adverse effects; Etanercept - therapeutic use; Female; Humans; Infliximab - administration & dosage; Infliximab - adverse effects; Infliximab - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; Receptors, Tumor Necrosis Factor - therapeutic use; Retrospective Studies; Spondylitis, Ankylosing - drug therapy; Treatment Failure; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1177/1060028016682330

Background: The introduction of anti–tumor necrosis factor α (anti-TNFα) drugs has improved the clinical outcomes in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). However, these drugs may cause adverse effects that motivate a change in or discontinuation of the treatment. Objective: To evaluate the causes of discontinuation or changes in the dosage regimen in a cohort of patients with RA and AS treated with infliximab, adalimumab, etanercept, and golimumab under clinical practice conditions. Methods: This was a retrospective observational study that included patients with RA or AS treated with anti-TNFα drugs between 2008 and 2013. Changes in the dosage regimen, reasons for treatment discontinuation, and adverse effects were recorded and analyzed. Time to discontinuation was estimated using Kaplan-Meier survival analysis. Results: A total of 123 patients with RA and 93 patients with AS were treated with anti-TNFα therapy. During the study, 55.3% of RA patients and 41.7% of AS patients had stopped the treatment. The most frequent changes were modifications in the dosing, and the most frequent adverse effects were reactions after the infusion or injection (53.8% and 66.7% in RA and AS, respectively). Drug survival of etanercept in RA (67.9%) is greater than for adalimumab and infliximab, whereas drug survival of infliximab in AS (70.0%) is greater than for etanercept and adalimumab at 5 years, although there were no significant differences (P = 0.098 in RA and 0.194 in AS). Conclusions: The main cause of discontinuation of anti-TNFα is therapeutic failure in both diseases. Etanercept and infliximab have the best survival rates in RA and AS, respectively.