RESEARCH - Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in RA

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Ann Rheum Dis 2011;70:583-589 doi:10.1136/ard.2010.139774

Clinical and epidemiological research

Extended report

Impact of concomitant use of DMARDs on the persistence with anti-TNF

therapies in patients with rheumatoid arthritis: results from the

British Society for Rheumatology Biologics Register

Moetaza M Soliman1, Darren M Ashcroft1, Kath D 2, Mark Lunt2,

Deborah P M Symmons2, Kimme L Hyrich2 on behalf of the British Society

for Rheumatology Biologics Register

1School of Pharmacy and Pharmaceutical Sciences, The University of

Manchester, Manchester, UK

2Arthritis Research UK Epidemiology Unit, The University of

Manchester, Manchester, UK

Abstract

Objective To evaluate the effect of different concomitant disease

modifying antirheumatic drugs (DMARDs) on the persistence with

antitumour necrosis factor (anti-TNF) therapies in patients with

rheumatoid arthritis (RA).

Method This analysis included 10 396 patients with RA registered with

the British Society for Rheumatology Biologics Register, a prospective

observational cohort study, who were starting their first anti-TNF

therapy and were receiving one of the following DMARD treatments at

baseline: no DMARD (n=3339), methotrexate (MTX) (n=4418), leflunomide

(LEF) (n=610), sulfasalazine (SSZ) (n=308), MTX+SSZ (n=902), MTX+

hydroxychloroquine (HCQ) (n=401) or MTX+SSZ+HCQ (n=418). Kaplan–Meier

survival analysis was used to study the persistence with anti-TNF

therapy in each DMARD subgroup up to 5 years. Multivariate

proportional hazard models, stratified by anti-TNF used and start year

and adjusted for a number of potential confounders, were used to

compare treatment persistence overall and according to the reason for

discontinuation between each of the DMARD subgroups, using MTX as

reference.

Results One-year drug survival (95% CI) for the first anti-TNF therapy

was 71% (71% to 72%) but this dropped to 42% (41% to 43%) at 5 years.

Compared with MTX, patients receiving no DMARD, LEF or SSZ were more

likely to discontinue their first anti-TNF therapy while patients

receiving MTX in combination with other DMARDs showed better treatment

persistence.

Conclusions These results support the continued use of background

DMARD combinations which include MTX. Consideration should be given to

the discontinuation of LEF and SSZ monotherapy at the time anti-TNF

therapies are started, with the possible exception of the SSZ+ETN

combination.

http://ard.bmj.com/content/70/4/583.abstract

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