RESEARCH - Changing patterns of TNF inhibitor use in 9074 patients with RA

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J Rheumatol. 2009 Mar 30.

Changing Patterns of Tumor Necrosis Factor Inhibitor Use in 9074

Patients with Rheumatoid Arthritis.

Yazici Y, Krasnokutsky S, JP, Hines PL, Wang J, Rosenblatt L.

From the New York University Hospital for Joint Diseases, New York,

New York; and Bristol-Myers Squibb, Princeton, New Jersey, USA.

OBJECTIVE: Patients with rheumatoid arthritis (RA) commonly switch

between tumor necrosis factor (TNF) inhibitors after failing to

control disease activity. Much of the clinical data that support

switching to a second TNF agent when one agent fails to work has come

from small, short-term studies. We utilized a US insurance claims

database to determine patterns of use such as dose escalation, time to

discontinuation, and switching between TNF inhibitors in patients with

RA.

METHODS: A retrospective analysis was performed using an insurance

claims database in the US from 2000 to 2005. TNF inhibitor use, time

to switch, dose escalation, and continuation times were analyzed in

patients with RA.

RESULTS: Nine thousand seventy-four patients with RA started TNF

inhibitors during the period 2000 to 2005. Etanercept was the most

commonly used TNF inhibitor; infliximab had the highest duration of

continuation, about 50% at 2 years. In addition, infliximab showed

higher rates of dose escalation compared to etanercept and adalimumab.

For all TNF inhibitors, time to switching decreased from 2000 to 2005.

CONCLUSION: TNF inhibitor use patterns changed from 2000 to 2005, with

more frequent changes among the different TNF inhibitors and a shorter

duration of treatment before the change. Only about 50% of TNF

inhibitors are still continued at 2 years, reflecting the difference

between randomized clinical trials and real-world experience.

PMID: 19332636

http://www.ncbi.nlm.nih.gov/pubmed/19332636

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