RESEARCH - Impact of concomitant DMARD therapy on adherence to treatment with Enbrel and Remicade in RA

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Impact of concomitant DMARD therapy on adherence to treatment with

etanercept and infliximab in rheumatoid arthritis. Results from a six-year

observational study in southern Sweden

Lars sen , Tore Saxne , Jan-Åke Nilsson and Pierre Geborek

Department of Rheumatology, Lund University Hospital, Kioskgatan 3, SE-221

85 Lund, Sweden

Arthritis Research & Therapy 2006, 8:R174

Published 22 November 2006

Abstract

The objective of this work is to compare the adherence to therapy of

patients receiving etanercept and infliximab during first tumour necrosis

factor (TNF)-blocking treatment course in rheumatoid arthritis. Special

emphasis is placed on potential predictors for treatment termination and the

impact of concomitant methotrexate (MTX) or other disease-modifying

antirheumatic drugs (DMARDs). Patients (n = 1,161) with active rheumatoid

arthritis, not responding to at least two DMARDs including MTX starting

etanercept or infliximab therapy for the first time, were included in a

structured clinical follow-up protocol. Information on diagnosis, disease

duration, previous and ongoing DMARDs, treatment start and termination, as

well as cause of withdrawal was prospectively collected during the period of

March 1999 through December 2004. Patients were divided into six groups

according to TNF-blocking drugs and concomitant DMARDs. Five-year level

(one-year) of adherence to therapy was 36% (69%) for patients receiving

infliximab in combination with MTX compared with 65% (89%) for patients

treated with etanercept and MTX (p < 0.001). regression models showed

that the risk for premature treatment termination of patients treated with

infliximab was threefold higher than for etanercept (p < 0.001). Also, the

regression analysis showed that patients receiving concomitant MTX had

better treatment continuation than patients treated solely with TNF blockers

(p < 0.001). Moreover, patients receiving concomitant MTX had superior drug

survival than patients receiving other concomitant DMARDs (p < 0.010). The

superior effect of MTX was associated primarily with fewer treatment

terminations because of adverse events. In addition, the study identifies

low C-reactive protein level, high age, elevated health assessment

questionnaire score, and higher previous number of DMARDs as predictors of

premature treatment termination.

In summary, treatment with etanercept has higher adherence to therapy than

treatment with infliximab. Concomitant MTX is associated with improved

treatment continuation of biologics when compared with both TNF blockers as

monotherapy and TNF blockers combined with other DMARDs.

Full text article here:

http://arthritis-research.com/content/8/6/R174

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