TY - JOUR
TI - Comparative analysis and predictors of 10-year tumor necrosis factor inhibitors drug survival in patients with spondyloarthritis: First-year response predicts longterm drug persistence
AU - Flouri, I.D.
AU - Markatseli, T.E.
AU - Boki, K.A.
AU - Papadopoulos, I.
AU - Skopouli, F.N.
AU - Voulgari, P.V.
AU - Settas, L.
AU - Zisopoulos, D.
AU - Iliopoulos, A.
AU - Geborek, P.
AU - Drosos, A.A.
AU - Boumpas, D.T.
AU - Sidiropoulos, P.
JO - Indian Journal of Rheumatology
PY - 2018
VL - 45
TODO - 6
SP - 785-794
PB - Journal of Rheumatology
SN - null
TODO - 10.3899/jrheum.170477
TODO - adalimumab;  etanercept;  golimumab;  infliximab;  methotrexate;  tumor necrosis factor inhibitor;  antirheumatic agent;  biological product;  infliximab;  tumor necrosis factor, adult;  ankylosing spondylitis;  Ankylosing Spondylitis Disease Activity Score;  arthritis;  Article;  biological therapy;  cohort analysis;  DAS28;  demyelinating disease;  drug retention;  drug use;  drug withdrawal;  female;  follow up;  human;  infection;  major clinical study;  male;  malignant neoplasm;  multicenter study;  observational study;  peripheral arthritis;  prospective study;  psoriasis;  psoriatic arthritis;  rash;  spondylarthritis;  tuberculosis;  comparative study;  middle aged;  psoriatic arthritis;  register;  spondylarthritis;  treatment outcome, Adalimumab;  Adult;  Antirheumatic Agents;  Arthritis, Psoriatic;  Biological Products;  Female;  Humans;  Infliximab;  Male;  Middle Aged;  Prospective Studies;  Registries;  Spondylarthritis;  Treatment Outcome;  Tumor Necrosis Factor-alpha
TODO - Objective. To evaluate the 10-year drug survival of the first tumor necrosis factor inhibitor (TNFi) administered to patients with spondyloarthritis (SpA) overall and comparatively between SpA subsets, and to identify predictors of drug retention. Methods. Patients with SpA in the Hellenic Registry of Biologic Therapies, a prospective multicenter observational cohort, starting their first TNFi between 2004-2014 were analyzed. Kaplan-Meier curves and Cox regression models were used. Results. Overall, 404 out of 1077 patients (37.5%) discontinued treatment (followup: 4288 patient-yrs). Ten-year drug survival was 49%. In the unadjusted analyses, higher TNFi survival was observed in patients with ankylosing spondylitis (AS) compared to undifferentiated SpA and psoriatic arthritis [PsA; significant beyond the first 2.5 (p = 0.003) years and 7 years (p < 0.001), respectively], and in patients treated for isolated axial versus peripheral arthritis (p = 0.001). In all multivariable analyses, male sex was a predictor for longer TNFi survival. Use of methotrexate (MTX) was a predictor in PsA and in patients with peripheral arthritis. Absence of peripheral arthritis and use of a monoclonal antibody (as opposed to non-antibody TNFi) independently predicted longer TNFi survival in axial disease because of lower rates of inefficacy. Achievement of major responses during the first year in either axial or peripheral arthritis was the strongest predictor of longer therapy retention (HR 0.33, 95% CI 0.26-0.41 for Ankylosing Spondylitis Disease Activity Score inactive disease, and HR 0.35, 95% CI 0.24-0.50 for 28-joint Disease Activity Score remission). Conclusion. The longterm retention of the first TNFi administered to patients with SpA is high, especially for males with axial disease. The strongest predictor of longterm TNFi survival is a major response within the first year of treatment. © 2018 The Journal of Rheumatology.
ER -