TY - JOUR
TI - 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
AU - Flouri, I.
AU - Markatseli, T.E.
AU - Voulgari, P.V.
AU - Boki, K.A.
AU - Papadopoulos, I.
AU - Settas, L.
AU - Zisopoulos, D.
AU - Skopouli, F.N.
AU - Iliopoulos, A.
AU - Bertsias, G.K.
AU - Geborek, P.
AU - Drosos, A.A.
AU - Boumpas, D.T.
AU - Sidiropoulos, P.
JO - Seminars in Arthritis and Rheumatism
PY - 2014
VL - 43
TODO - 4
SP - 447-457
PB - 
SN - 0049-0172
TODO - 10.1016/j.semarthrit.2013.07.011
TODO - 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
TODO - 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.
ER -