RESEARCH - Comparison of Humira, Enbrel, and Remicade: DANBIO

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Arthritis Rheum. 2009 Dec 28;62(1):22-32.

Direct comparison of treatment responses, remission rates, and drug

adherence in patients with rheumatoid arthritis treated with

adalimumab, etanercept, or infliximab: Results from eight years of

surveillance of clinical practice in the nationwide Danish DANBIO

registry.

Hetland ML, Christensen IJ, Tarp U, Dreyer L, Hansen A, Hansen IT,

Kollerup G, Linde L, Lindegaard HM, Poulsen UE, Schlemmer A, Jensen

DV, Jensen S, Hostenkamp G, Ostergaard M; All Departments of

Rheumatology in Denmark.

DANBIO Registry, and Copenhagen University Hospital, Hvidovre and

Glostrup, Denmark.

OBJECTIVE: To compare tumor necrosis factor alpha inhibitors directly

regarding the rates of treatment response, remission, and the drug

survival rate in patients with rheumatoid arthritis (RA), and to

identify clinical prognostic factors for response.

METHODS: The nationwide DANBIO registry collects data on rheumatology

patients receiving routine care. For the present study, we included

patients from DANBIO who had RA (n = 2,326) in whom the first biologic

treatment was initiated (29% received adalimumab, 22% received

etanercept, and 49% received infliximab). Baseline predictors of

treatment response were identified. The odds ratios (ORs) for clinical

responses and remission and hazard ratios (HRs) for drug withdrawal

were calculated, corrected for age, disease duration, the Disease

Activity Score in 28 joints (DAS28), seropositivity, concomitant

methotrexate and prednisolone, number of previous disease-modifying

drugs, center, and functional status (Health Assessment Questionnaire

score).

RESULTS: Seventy percent improvement according to the American College

of Rheumatology criteria (an ACR70 response) was achieved in 19% of

patients after 6 months. Older age, concomitant prednisolone

treatment, and low functional status at baseline were negative

predictors. The ORs (95% confidence intervals [95% CIs]) for an ACR70

response were 2.05 (95% CI 1.52-2.76) for adalimumab versus

infliximab, 1.78 (95% CI 1.28-2.50) for etanercept versus infliximab,

and 1.15 (95% CI 0.82-1.60) for adalimumab versus etanercept. Similar

predictors and ORs were observed for a good response according to the

European League Against Rheumatism criteria, DAS28 remission, and

Clinical Disease Activity Index remission. At 48 months, the HRs for

drug withdrawal were 1.98 for infliximab versus etanercept (95%

1.63-2.40), 1.35 for infliximab versus adalimumab (95% CI 1.15-1.58),

and 1.47 for adalimumab versus etanercept (95% CI 1.20-1.80).

CONCLUSION: Older age, low functional status, and concomitant

prednisolone treatment were negative predictors of a clinical response

and remission. Infliximab had the lowest rates of treatment response,

disease remission, and drug adherence, adalimumab had the highest

rates of treatment response and disease remission, and etanercept had

the longest drug survival rates. These findings were consistent after

correction for confounders and sensitivity analyses and across outcome

measures and followup times.

PMID: 20039405

http://www.ncbi.nlm.nih.gov/pubmed/20039405

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