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Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival

Flouri, Irini; Markatseli, Theodora E.; Voulgari, Paraskevi V.; Boki, Kyriaki A.; Papadopoulos, Ioannis; Settas, Loukas; Zisopoulos, Dimitrios; Skopouli, Fotini N.; Iliopoulos, Alexios and Bertsias, George K., et al. (2014) In Seminars in Arthritis and Rheumatism 43(4). p.447-457
Abstract
Objective: To compare effectiveness, drug survival, and safety between infliximab, adalimumab, and etanercept, in a nationwide cohort of rheumatoid arthritis (RA) patients. Methods: This study is a prospective cohort study of 1208 active RA patients. Effectiveness, drug survival, and serious adverse events during entire follow-up (median 2.9 years) were monitored. Results: EULAR and CDAI responses were comparable between the three agents (EULAR good/moderate responses at 12 months ranged 76-79%). At 12 months, 15-23% achieved remission. For adalimumab and etanercept, adjusted hazard rate (HR) for EULAR/ACR remission (reference: infliximab) was 2.7 and 2.1 (95% confidence interval was 1.7-4.1 and 1.3-3.4, respectively); males (HR 1.6;... (More)
Objective: To compare effectiveness, drug survival, and safety between infliximab, adalimumab, and etanercept, in a nationwide cohort of rheumatoid arthritis (RA) patients. Methods: This study is a prospective cohort study of 1208 active RA patients. Effectiveness, drug survival, and serious adverse events during entire follow-up (median 2.9 years) were monitored. Results: EULAR and CDAI responses were comparable between the three agents (EULAR good/moderate responses at 12 months ranged 76-79%). At 12 months, 15-23% achieved remission. For adalimumab and etanercept, adjusted hazard rate (HR) for EULAR/ACR remission (reference: infliximab) was 2.7 and 2.1 (95% confidence interval was 1.7-4.1 and 1.3-3.4, respectively); males (HR 1.6; 1.1-2.4), use of glucocorticoids (HR 2.0; 13-3.0), and swollen joint count > 7 (HR 0.36; 0.24-0.55) were independent predictors. Five-year drug survival was 31%, 43%, and 49% for infliximab, adalimumab, and etanercept, respectively (p = 0.010). Infliximab was associated with significantly more withdrawals due to adverse events. Disease activity, CRP, and use of glucocorticoids predicted efficacy-related drug survival; age, use of methotrexate, and prior DMARDs failures predicted safety-related survival. Risk for serious infections was lower with adalimumab (odds ratio [OR] 0.62; 0.38-1.00) or etanercept (OR 0.39; 0.21-0.72) than infliximab, independent of the effects of age (OR 1.65; 1.37-2.00 per 10 years), tender joint count > 10 (OR 1.86; 1.21-2.86), and glucocorticoids >35 mg/week (OR 1.83; 1.12-2.99). Conclusions: Response rates were comparable among anti-TNF agents. Overall, 5-year drug survival was below 50%, with infliximab demonstrating increased safety-related discontinuations. Remission rates are low in clinical practice. Strategies to increase effectiveness and long-term survival of anti-TNF agents in RA are needed. (C) 2014 Elsevier Inc. All rights reserved. (Less)
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Arthritis, Biological therapies, Efficacy, Safety, Infections, Glucocorticoids, Registry
in
Seminars in Arthritis and Rheumatism
volume
43
issue
4
pages
447 - 457
publisher
W.B. Saunders Co.
external identifiers
  • wos:000331598400004
  • scopus:84894903634
ISSN
0049-0172
DOI
10.1016/j.semarthrit.2013.07.011
language
English
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c120cb97-7ec3-4bdc-bf8f-cfe17bd6308f (old id 4364213)
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2014-04-07 09:20:15
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@article{c120cb97-7ec3-4bdc-bf8f-cfe17bd6308f,
  abstract     = {Objective: To compare effectiveness, drug survival, and safety between infliximab, adalimumab, and etanercept, in a nationwide cohort of rheumatoid arthritis (RA) patients. Methods: This study is a prospective cohort study of 1208 active RA patients. Effectiveness, drug survival, and serious adverse events during entire follow-up (median 2.9 years) were monitored. Results: EULAR and CDAI responses were comparable between the three agents (EULAR good/moderate responses at 12 months ranged 76-79%). At 12 months, 15-23% achieved remission. For adalimumab and etanercept, adjusted hazard rate (HR) for EULAR/ACR remission (reference: infliximab) was 2.7 and 2.1 (95% confidence interval was 1.7-4.1 and 1.3-3.4, respectively); males (HR 1.6; 1.1-2.4), use of glucocorticoids (HR 2.0; 13-3.0), and swollen joint count > 7 (HR 0.36; 0.24-0.55) were independent predictors. Five-year drug survival was 31%, 43%, and 49% for infliximab, adalimumab, and etanercept, respectively (p = 0.010). Infliximab was associated with significantly more withdrawals due to adverse events. Disease activity, CRP, and use of glucocorticoids predicted efficacy-related drug survival; age, use of methotrexate, and prior DMARDs failures predicted safety-related survival. Risk for serious infections was lower with adalimumab (odds ratio [OR] 0.62; 0.38-1.00) or etanercept (OR 0.39; 0.21-0.72) than infliximab, independent of the effects of age (OR 1.65; 1.37-2.00 per 10 years), tender joint count > 10 (OR 1.86; 1.21-2.86), and glucocorticoids >35 mg/week (OR 1.83; 1.12-2.99). Conclusions: Response rates were comparable among anti-TNF agents. Overall, 5-year drug survival was below 50%, with infliximab demonstrating increased safety-related discontinuations. Remission rates are low in clinical practice. Strategies to increase effectiveness and long-term survival of anti-TNF agents in RA are needed. (C) 2014 Elsevier Inc. All rights reserved.},
  author       = {Flouri, Irini and Markatseli, Theodora E. and Voulgari, Paraskevi V. and Boki, Kyriaki A. and Papadopoulos, Ioannis and Settas, Loukas and Zisopoulos, Dimitrios and Skopouli, Fotini N. and Iliopoulos, Alexios and Bertsias, George K. and Geborek, Pierre and Drosos, Alexandros A. and Boumpas, Dimitrios T. and Sidiropoulos, Prodromos},
  issn         = {0049-0172},
  keyword      = {Arthritis,Biological therapies,Efficacy,Safety,Infections,Glucocorticoids,Registry},
  language     = {eng},
  number       = {4},
  pages        = {447--457},
  publisher    = {W.B. Saunders Co.},
  series       = {Seminars in Arthritis and Rheumatism},
  title        = {Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival},
  url          = {http://dx.doi.org/10.1016/j.semarthrit.2013.07.011},
  volume       = {43},
  year         = {2014},
}