ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2383

The 12-Years Retention Rate of the First-Line TNF-Inhibitor in the Treatment of Rheumatoid Arthritis: Real-Life Data from a Local Registry

Ennio Giulio Favalli1, Martina Biggioggero2, Francesca Pregnolato3, Andrea Becciolini2, Alessandra Emiliana Penatti2, Antonio Marchesoni4 and Pier Luigi Meroni2, 1Department of Rheumatology, Gaetano Pini Institute, Milan, Italy, 2Chair and Division of Rheumatology, Gaetano Pini Institute, University of Milan, Milan, Italy, 3Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS, Istituto Auxologico Italiano, Milan, Italy, 4Rheumatology, Department of Rheumatology, Gaetano Pini Institute, Milan, Italy

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Impact of Various Interventions and Therapeutic Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose

Data on over-10-years drug survival of TNF inhibitors (TNFi) are still lacking. The aim of the study is to analysed the long-term retention rate of the first TNFi and to compare the drug survival of infliximab (IFX), etanercept (ETN) and adalimumab (ADA) for the treatment of rheumatoid arthritis (RA) in a setting of real-life. 

Methods

We extracted data from a local registry that includes all RA patients (all fulfilling ACR/EULAR 2010 classification criteria) treated with biologic therapies between October 1999 and May 2014 in our Rheumatology Unit, limiting the analysis to patients treated with IFX, ETN, or ADA as first-line biologic drug. Data were collected through 31 May 2014. Drug survival up to 12-year follow-up was evaluated overall by the Kaplan-Meier method and compared according to anti-TNF agent after matching for propensity scores (based on age, sex, health assessment questionnaire [HAQ], disease duration, concomitant DMARDs therapy, concomitant corticosteroids, Disease Activity Score 28 [DAS28], ESR and CRP) by a stratified logrank test. 

Results

The analysis included 583 patients (mean age [±SD]=54 [±12.4] years, mean disease duration 8.6 [±18.9] years), treated with IFX (n=222), ADA (n=182), or ETN (n=179). The median time of receiving TNFi was 44.3 months and the overall 5-years and 12-years TNFi retention rates were 44.1% and 19.39%, respectively. Drug inefficacy (51.1%) and toxicity (41.2%) represented the main causes of treatment discontinuation. Combination with MTX was significantly associated with a higher TNFi retention rate (p<0.01). ETN showed a significant lower probability of discontinuation compared with both IFX (z=6.52, p<0.0001) and ADA (z=5.66, p<0.0001). No significant differences emerged between IFX and ADA (z=0.19, p=0.85). 

Conclusion

In a real-life setting, the 12-years retention rate of the first TNFi was lower than 20% and the most frequent reason for discontinuation was inefficacy (51.1%). The drug survival of ETN was significantly higher compared with anti-TNF monoclonal antibodies.

Disclosure:

E. G. Favalli,
None;

M. Biggioggero,
None;

F. Pregnolato,
None;

A. Becciolini,
None;

A. E. Penatti,
None;

A. Marchesoni,
None;

P. L. Meroni,
None.

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