RESEARCH - The effectiveness of Arava as a co-therapy of TNF inhibitors in RA

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ls of the Rheumatic Diseases 2009;68:33-39

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CLINICAL AND EPIDEMIOLOGICAL RESEARCH

The effectiveness of leflunomide as a co-therapy of tumour necrosis

factor inhibitors in rheumatoid arthritis: a population-based study

A Finckh 1, S Dehler 2, C Gabay 1 on behalf of the SCQM doctors

1 Department of Medicine, Division of Rheumatology, Geneva University

Hospital, Geneva, Switzerland

2 SCQM Foundation, Department of Social and Preventive Medicine,

University of Zurich, Switzerland

Background: Randomised trials have demonstrated that the efficacy of

anti-tumour necrosis factor (TNF) agents is significantly increased by

concomitant methotrexate (MTX) in rheumatoid arthritis (RA). In

clinical routine, anti-TNF agents are commonly prescribed with other

disease-modifying antirheumatic drugs (DMARDs) than MTX, however their

effectiveness in combination with anti-TNF agents is not well

established.

Objective: To compare the effectiveness of leflunomide (LEF) and other

conventional DMARDs with MTX as co-therapy to anti-TNF agents in RA.

Methods: All patients on anti-TNF agents and conventional DMARDs

within the Swiss Clinical Quality Management (SCQM)-RA database were

included (n = 1218) and categorised according to the type of

co-therapy into anti-TNF+MTX (n = 842), anti-TNF+LEF (n = 260) and

anti-TNF+other DMARDs (n = 116). Drug discontinuation rates and

incidence of toxic side effects were analysed using proportional

hazard models. Progression of radiographic damage, the evolution of

functional disability and the improvement of RA disease activity were

analysed using longitudinal regression models, adjusting for potential

confounders.

Results: The overall discontinuation rates of anti-TNF and

conventional DMARD combination therapies were relatively high with a

median survival of only 16 months (interquartile range (IQR): 10–37),

but they did not differ between the three regimens (p = 0.69). The

progression of radiographic damage (p = 0.77), functional disability

(p = 0.09) and RA disease activity (p = 0.33) were also similar

between the different regimen. In addition, no significant difference

in the frequency of adverse events emerged.

Conclusion: Overall these results suggest that LEF and potentially

other conventional DMARDs offer an effective and safe alternative to

MTX as co-therapy in combination with anti-TNF agents.

http://ard.bmj.com/cgi/content/abstract/68/1/33?etoc

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