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Presence of peripheral arthritis and male sex predicting continuation of anti–tumor necrosis factor therapy in ankylosing spondylitis: An observational prospective cohort study from the South Swedish arthritis treatment group register

Kristensen, Lars Erik LU ; Karlsson, Johan LU ; Englund, Martin LU ; Petersson, Ingemar LU ; Saxne, Tore LU and Geborek, Pierre LU (2010) In Arthritis Care and Research1988-01-01+01:002000-01-01+01:00 62(10). p.1362-1369
Abstract
Objective:

To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice.



Methods:

Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic... (More)
Objective:

To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice.



Methods:

Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years.



Results:

The 2-year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19–0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27–0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25–1.04], P = 0.062), whereas no differences were found comparing the 3 anti–tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level (HR 0.99 [95% CI 0.97–1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34–1.10], P = 0.10) also showed trends to entail better drug adherence.



Conclusion:

AS patients in this study have an excellent 2-year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Arthritis Care and Research1988-01-01+01:002000-01-01+01:00
volume
62
issue
10
pages
1362 - 1369
publisher
John Wiley & Sons
external identifiers
  • wos:000283185300002
  • pmid:20506310
  • scopus:77957666794
ISSN
2151-4658
DOI
10.1002/acr.20258
language
English
LU publication?
yes
id
584896e4-0655-4f2d-a3fd-a253c8f3e86d (old id 1609837)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20506310?dopt=Abstract
date added to LUP
2010-06-02 15:16:38
date last changed
2018-06-24 03:11:34
@article{584896e4-0655-4f2d-a3fd-a253c8f3e86d,
  abstract     = {Objective:<br/><br>
To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice.<br/><br>
<br/><br>
Methods:<br/><br>
Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years.<br/><br>
<br/><br>
Results:<br/><br>
The 2-year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19–0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27–0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25–1.04], P = 0.062), whereas no differences were found comparing the 3 anti–tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level (HR 0.99 [95% CI 0.97–1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34–1.10], P = 0.10) also showed trends to entail better drug adherence.<br/><br>
<br/><br>
Conclusion:<br/><br>
AS patients in this study have an excellent 2-year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.},
  author       = {Kristensen, Lars Erik and Karlsson, Johan and Englund, Martin and Petersson, Ingemar and Saxne, Tore and Geborek, Pierre},
  issn         = {2151-4658},
  language     = {eng},
  number       = {10},
  pages        = {1362--1369},
  publisher    = {John Wiley & Sons},
  series       = {Arthritis Care and Research1988-01-01+01:002000-01-01+01:00},
  title        = {Presence of peripheral arthritis and male sex predicting continuation of anti–tumor necrosis factor therapy in ankylosing spondylitis: An observational prospective cohort study from the South Swedish arthritis treatment group register},
  url          = {http://dx.doi.org/10.1002/acr.20258},
  volume       = {62},
  year         = {2010},
}