Background/Purpose: The wide use of biological therapies (BTs) has largely modified the therapeutic approach in Chronic Inflammatory Arthritis (CIA). These relatively new drugs have different molecular structure, pharmacokinetic properties and their survival in clinical practice is not well established. The aim of the present study was to analyze the survival of different biological therapies in patients with CIA (i.e. rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA)) and to compare this survival between the three diseases in clinical practice.

Methods:

The present study is a retrospective and observational study of patients with CIA treated with BT from December 1999 to December 2012, followed in a university hospital. A large number of epidemiological and clinical data were analyzed (i.e. gender, age, disease diagnosis, date of diagnosis and several variables related to the treatment). Phase I of the study was focused in the analysis of the relationship between clinical (i.e. RF, ACPA, presence of erosions and previous biological therapies) and epidemiologic variables, with the survival curves and treatment discontinuation rate (DR) in RA patients. In Phase II, we compared the survival curves between AS and PsA with RA. Multivariate analysis was used to adjust for potential confounder factors.

Statistical analysis was performed using the R statistical software. Survival curves were generated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was used to detect the rate of discontinuation and to evaluate the effect of different covariates

Results:

300 CIA clinical records were analyzed and data from 291 CIA patients were finally included (RA n=221, AS n=39, PsA n=31). In these 291 patients, a total of 614 BTs were identified (RA n=488, AS n=69, PsA n=57). In Phase I we found that etanercept showed a significant difference in DR (P=9.08e-5) when it was compared with other BTs (HR= 0.63 [95% CI, 0.49-0.79). The number of previous BTs (P– Value= 2.24 E-0.3) and previous DMARDs (P-Value=3.14 E-0.6) were significant variables in DR.  

When DR and survival curves were compared between the three CIA we did not find differences in the survival curves in PsA patients compared to RA patients. However, we found a highly significant difference in AS patients compared to the RA patients (P– Value= 5.85E-0.5), showing a lower DR (HR= 0.49 [95% CI, 0.35-0.70]). 

Conclusion: In our series of patients with chronic inflammatory arthritis treated with biological therapies, we found that etanercept is the treatment with the highest survival in rheumatoid arthritis patients. We also found that ankylosing spondylitis is the chronic arthritis where biological therapies have the longest survival.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/survival-of-biological-treatment-in-chronic-inflammatory-arthritis-a-preliminary-analysis-of-13-years-of-follow-up-in-clinical-practice/