Long Term Drug Survival of Adalimumab and Etanercept Treatment for Rheumatoid Arthritis with and without Methotrexate

I.M Visman¹, MJ l'Ami², Gertjan Wolbink³ and Mike T. Nurmohamed^4,5, ¹Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands, ²Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, Netherlands, ³Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, Netherlands, ⁴Rheumatology, Reade, Amsterdam Rheumatology and immunology Center, Amsterdam, Netherlands, ⁵Rheumatology, Amsterdam Rheumatology and immunology Center, VU University medical center, Amsterdam, Netherlands

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Adalimumab, biologic response modifiers, etanercept, methotrexate (MTX) and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster III: Treatment – Monitoring, Outcomes, Adverse Events

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Tumor necrosis factor alpha (TNF-α) inhibitors are effective, safe and widely used treatment for rheumatoid arthritis (RA). The therapy is often started in combination with methotrexate (MTX). However, less is known about the effectiveness of the combination with (or without) MTX on long term TNF-α inhibitor use. The aim of this study was to assess the nine year drug survival of patients started on etanercept or adalimumab treatment with or without concomitant MTX.

Methods: A total of 1230 consecutive patients were included in the etanercept (EtRA, n=643, 52%) and adalimumab (AdRA, n=587, 48%) cohort at the Jan van Breemen research centre in Amsterdam, The Netherlands, from Feb 6^th 2004 to March 12^th 2014. The choice of biological was determined by the treating rheumatologist. If patients switched between both biologicals, only the first biological was used in this study. All patients fulfilled the American College of Rheumatology classification criteria for RA. Drug survival was assessed with Cox Regression.

Results: For etanercept, 186 (28%) used MTX at baseline and 371 (58%) dropped out. Median survival was 1.6 (0.4-4.0) and maximum survival was 9.2 years. In the adalimumab treated group, 373 (64%) used MTX at baseline and 350 (60%) dropped out. Median survival was 1.3 (0.4-4.4)and maximum survival was 9.3 years. Adalimumab patients without MTX were 2.61 (2.11-3.24) times more likely to drop-out than adalimumab patients with concomitant MTX (Figure 1). For etanercept treated patients this was 1.23 (0.98-1.54) for those with versus without MTX.

Conclusion: Although the drug survival of etanercept patients with and without MTX differed slightly, there was a much greater difference in the drug survival of adalimumab patients with MTX versus without MTX. This is probably due to the inhibition of anti-adalimumab antibody formation by MTX, whereas no clinically relevant antibodies for etanercept have been found. Whether or not the choice for adalimumab or etanercept should be guided by tolerance for MTX remains to be established.

Disclosure: I. M. Visman, None; M. l'Ami, None; G. Wolbink, None; M. T. Nurmohamed, None.

To cite this abstract in AMA style:

Visman IM, l'Ami M, Wolbink G, Nurmohamed MT. Long Term Drug Survival of Adalimumab and Etanercept Treatment for Rheumatoid Arthritis with and without Methotrexate [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/long-term-drug-survival-of-adalimumab-and-etanercept-treatment-for-rheumatoid-arthritis-with-and-without-methotrexate/. Accessed .

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