Drug Survival Rates Of Anti-Tumor Necrosis Factor Therapies In Patients With Rheumatoid Arthritis and Ankylosing Spondylitis

Dong-Jin Park¹, Kyung-Eun Lee¹, Ji-Hyoun Kang², Jeong-Won Lee², Tae-Jong Kim³, Yong-Wook Park¹ and Shin-Seok Lee⁴, ¹Rheumatology, Chonnam National University Medical School, Gwangju, South Korea, ²Chonnam National University Medical School, Gwangju, South Korea, ³Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea, ⁴Dept of Int Med/Rheumatology, Chonnam National University Medical School, Gwangju, South Korea

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), rheumatoid arthritis, treatment and tumor necrosis factor (TNF)

Session Information

Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy III

Session Type: Abstract Submissions (ACR)

Background/Purpose: We investigated the compliance of Korean patients using anti-tumor necrosis factor (TNF) agents to treat rheumatoid arthritis (RA) and anklyosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation.

Methods: The study population comprised 114 RA and 310 AS patients treated with anti-TNF agents at a single tertiary center for at least 1 year from December 2002 to November 2011. Demographic, clinical, laboratory, and treatment-related data at the time of initiation of anti-TNF agents were collected, and the cause of discontinuation was also determined by reviewing patients’ charts. Survival curves were plotted to compare the drug survival between three different anti-TNF agents; life-table analysis and multivariate Cox proportional hazard models were used to identify predictors of treatment discontinuation of anti-TNF therapy.

Results: Of the 114 RA patients, 64 (56.1%) discontinued their first anti-TNF agents with a mean duration of 18.1 months. In constrast, 65 of 310 patients (21.0%) with AS discontinued their first anti-TNF agents, with a mean duration of 84 months. Over a mean follow-up of 33.8 months (range, 10–77 months), the 1-year and 4-year drug survival rates were 44% and 37% in RA patients and 79% and 67% in AS patients, respectively. Although the survival rate did not differ among the three anti-TNF agents in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. The most common cause of discontinuation of anti-TFF agents in RA patients was inefficacy, which was reported by 43 (67.2%) patients for all anti-TNF agents, whereas the reasons for discontinuation in AS patients were adverse events (39.7%), inefficacy (33.3%), intention of paitents (9.5%), economic status (11.1%), hospitalization (3.2%), and lost to follow-up (3.2%). In addition, RA patients who received corticosteroids in combination with anti-TNF agents were more likely to discontinue their anti-TNF therapies. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint.

Conclusion: We found that AS patients had a higher continuation rate of anti-TNF agent treatment compared to RA paitents and identified predictive variables for drug discontinuation in these paitents. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials.

Disclosure:

D. J. Park,
None;

K. E. Lee,
None;

J. H. Kang,
None;

J. W. Lee,
None;

T. J. Kim,
None;

Y. W. Park,
None;

S. S. Lee,
None.

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