RESEARCH - Comparison of drug retention rates and causes of drug discontinuation between anti-TNF agents in RA

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Arthritis Rheum. 2009 Apr 29;61(5):560-568.

Comparison of drug retention rates and causes of drug discontinuation

between anti-tumor necrosis factor agents in rheumatoid arthritis.

Pan SM, Dehler S, Ciurea A, Ziswiler HR, Gabay C, Finckh A; Swiss

Clinical Quality Management Physicians.

Geneva University Hospital, Geneva, Switzerland.

OBJECTIVE: Tumor necrosis factor (TNF) inhibitors have revolutionized

the treatment of severe rheumatoid arthritis (RA), yet drug

discontinuation is common. The aim of this study was to compare

treatment retention rates and specific causes of anti-TNF

discontinuation in a population-based RA cohort.

METHODS: All patients treated with etanercept, infliximab, or

adalimumab within the Swiss Clinical Quality Management RA cohort

between 1997 and 2006 were included in the study. Causes of treatment

discontinuation were broadly categorized as adverse events (AEs) or

nontoxic causes, and further subdivided into specific categories.

Specific causes of treatment interruption were analyzed using a

proportional hazards model and adjusted for potential confounders.

RESULTS: A total of 2,364 anti-TNF treatment courses met the inclusion

criteria. Treatment discontinuation was reported 803 times: 309 with

etanercept, 249 with infliximab, and 245 with adalimumab. Drug

inefficacy represented the largest single cause of treatment

discontinuation (55.8% of cases). The median time of receiving

anti-TNF therapy was 37 months, but discontinuation rates differed

between the 3 anti-TNF agents (P < 0.001), with shorter retention

rates for infliximab (hazard ratio

---

1.24, 99% confidence interval

[99% CI] 1.01-1.51). The specific causes of treatment discontinuation

revealed an increased risk of AEs with infliximab (HR 1.4, 99% CI

1.003-1.96), mostly due to an increased risk of infusion or allergic

reactions (HR 2.11, 99% CI 1.23-3.62). Other discontinuation causes

were equally distributed between the anti-TNF agents.

CONCLUSION: In this population, infliximab was associated with higher

overall discontinuation rates compared with etanercept and adalimumab,

which is mainly due to an increased risk of infusion or allergic

reactions.

PMID: 19405000

http://www.ncbi.nlm.nih.gov/pubmed/19405000

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