Background/Purpose

Several anti-TNFs are currently approved in Europe for RA treatment including certolizumab pegol (CZP), adalimumab (ADA), etanercept (ETN), golimumab and infliximab. UK NICE guidance recommends CZP as a first-line biologic therapy for patients (pts) with RA, in conjunction with a Pt Access Scheme that provides CZP free of charge for the first 12 weeks (wks). The objective was to assess real-world CZP, and other subcutaneous anti-TNFs (ADA or ETN), RA pt characteristics and treatment utilization in the UK.

Methods

A descriptive, retrospective, observational chart analysis was conducted in 4 UK rheumatology clinics. Medical data were collected over 52(-6/+9) wks for biologic-naïve pts initiating an anti-TNF (N=187); visit schedule was not prescribed therefore exact visit timing varied across pts. Data are reported for CZP pts and those receiving Other Anti-TNFs. Treatment persistency was assessed up to Wk52 using Kaplan-Meier estimates with pts censored at treatment discontinuation (ie. stop first anti-TNF treatment and switch to another/stop anti-TNFs) and excluding reinitiators (ie. pts with a gap in therapy returning to treatment within follow-up period).

Results

Baseline (BL) data were available for 110 CZP pts and 77 pts receiving Other Anti-TNFs (Figure 1A). At initiation, 14.5% (16/110) and 20.8% (16/77) pts received CZP and Other Anti-TNF monotherapy, respectively. Of those receiving combination therapy, 79.8% (75/94) CZP and 78.7% (48/61) Other Anti-TNF pts received concomitant MTX.

Due to the retrospective nature of data collection, not every pt had all data available; data were collected for 110, 108, 82 CZP pts and 77, 74, 50 Other Anti-TNF pts over 12, 24, 52 wks, respectively. Treatment persistency was 95.5%, 82.6%, 71.8% for CZP and 90.9%, 73.5%, and 65.0% for Other Anti-TNF pts at 12, 24, 52 wks, respectively (all lower bounds above 60% for corresponding CIs) (Figure 1B). Mean treatment persistency was 46.3 (95% CI: 43.2–49.4) and 43.1 (95% CI: 38.5–47.7) wks for CZP and Other Anti-TNF pts, respectively. Of pts initiating CZP, 2.7% switched therapy to another anti-TNF at any time during follow-up (n=3; 1 pt each 0-11, 12-24, 25-52 wks). Similarly, 6.5% of Other Anti-TNF pts switched to another anti-TNF (n=5; 4 pts before Wk12, 1 pt 12-24 wks). Compared to CZP pts, the risk of discontinuation in the Other Anti-TNF group was 37.4% greater (Hazard Ratio=1.374; 0.820-2.302). The majority of discontinuations occurred within the first 24 wks for both groups.

Conclusion

In this descriptive study, BL demographics/disease activity for pts treated with anti-TNFs in the UK were broadly similar between groups. Treatment persistency in this real-world observational study was also similar between CZP and Other Anti-TNFs in anti-TNF naïve pts. Interpretation of data is limited due to general caveats inherent to retrospective analyses.