@article{3126961,
    title = "Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival",
    author = "Flouri, I. and Markatseli, T.E. and Voulgari, P.V. and Boki, K.A. and Papadopoulos, I. and Settas, L. and Zisopoulos, D. and Skopouli, F.N. and Iliopoulos, A. and Bertsias, G.K. and Geborek, P. and Drosos, A.A. and Boumpas, D.T. and Sidiropoulos, P.",
    journal = "Seminars in Arthritis and Rheumatism",
    year = "2014",
    volume = "43",
    number = "4",
    pages = "447-457",
    issn = "0049-0172",
    doi = "10.1016/j.semarthrit.2013.07.011",
    keywords = "Arthritis;  Biological therapies;  Efficacy;  Glucocorticoids;  Infections;  Registry;  Safety, Adult;  Aged;  Antibodies, Monoclonal;  Antibodies, Monoclonal, Humanized;  Antirheumatic Agents;  Arthritis, Rheumatoid;  Female;  Follow-Up Studies;  Humans;  Immunoglobulin G;  Male;  Middle Aged;  Prospective Studies;  Receptors, Tumor Necrosis Factor;  Registries;  Severity of Illness Index;  Treatment Outcome",
    abstract = "Objective: To compare effectiveness, drug survival, and safety between infliximab, adalimumab, and etanercept, in a nationwide cohort of rheumatoid arthritis (RA) patients. Methods: This study is a prospective cohort study of 1208 active RA patients. Effectiveness, drug survival, and serious adverse events during entire follow-up (median 2.9 years) were monitored. Results: EULAR and CDAI responses were comparable between the three agents (EULAR good/moderate responses at 12 months ranged 76-79%). At 12 months, 15-23% achieved remission. For adalimumab and etanercept, adjusted hazard rate (HR) for EULAR/ACR remission (reference: infliximab) was 2.7 and 2.1 (95% confidence interval was 1.7-4.1 and 1.3-3.4, respectively); males (HR 1.6; 1.1-2.4), use of glucocorticoids (HR 2.0; 1.3-3.0), and swollen joint count >7 (HR 0.36; 0.24-0.55) were independent predictors. Five-year drug survival was 31%, 43%, and 49% for infliximab, adalimumab, and etanercept, respectively (p = 0.010). Infliximab was associated with significantly more withdrawals due to adverse events. Disease activity, CRP, and use of glucocorticoids predicted efficacy-related drug survival; age, use of methotrexate, and prior DMARDs failures predicted safety-related survival. Risk for serious infections was lower with adalimumab (odds ratio [OR] 0.62; 0.38-1.00) or etanercept (OR 0.39; 0.21-0.72) than infliximab, independent of the effects of age (OR 1.65; 1.37-2.00 per 10 years), tender joint count >10 (OR 1.86; 1.21-2.86), and glucocorticoids >35. mg/week (OR 1.83; 1.12-2.99). Conclusions: Response rates were comparable among anti-TNF agents. Overall, 5-year drug survival was below 50%, with infliximab demonstrating increased safety-related discontinuations. Remission rates are low in clinical practice. Strategies to increase effectiveness and long-term survival of anti-TNF agents in RA are needed. © 2014 Elsevier Inc."
}