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Long-term TNF inhibitor retention high in spondyloarthritis
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Patients with spondyloarthritis — particularly men with axial disease — had high rates of drug retention of the first TNF inhibitor over 5- and 10-year time periods, according to findings published in the Journal of Rheumatology.
The researchers further noted that the strongest predictor of long-term retention of first TNF inhibitor is a major response within the first year of treatment.
“In addition to randomized clinical studies, valuable information to optimize clinical use of these novel and expensive drugs is provided by real-life evidence from registries and cohort studies,” Irini D. Flouri, MD, of the University of Crete, and colleagues wrote. “However, most of these studies have focused on individual clinical subtypes within the spectrum of [spondyloarthritis (SpA)], mainly ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Only a limited number of studies, mainly in the early years of TNF inhibitor use and with short-term follow-up, analyzed patients with SpA as a whole group and compared data between sub-diagnoses.”
To determine the 10-year retention rate of first TNF inhibitor treatment among patients with SpA and its subsets, as well as to identify the predictors of drug survival, the researchers analyzed 1,077 patients with inflammatory disease in the Hellenic Registry of Biologic Therapies (HeRBT), a prospective, observational cohort of patients who were treated with biologic therapies at seven referral centers across Greece. Those with a primary diagnosis of SpA who began receiving TNF inhibitors between Jan. 1, 2004, and Dec. 31, 2014, were included in the study.
The primary outcome was the 10-year drug survival in the entire study cohort, as well as the various causes and predictors of treatment discontinuation. Secondary outcomes were drug survival according to the sub-diagnoses of AS and PsA, and the presence of axial or peripheral arthritis. Flouri and colleagues calculated drug retention as the time between the beginning of treatment and the date of either the first missed dose, death or April 30, 2015.
According to researchers, 37.5% of patients included in the study discontinued treatment. Overall, the 10-year rate of drug survival was 49%. After performing a multivariate analysis, the researchers found that male sex was a predictor of longer drug survival. The use of methotrexate was a predictor of TNF inhibitor survival among patients with PsA and those with peripheral arthritis. In addition, major response to the therapy in the first year of treatment among patients with either axial or peripheral arthritis was the strongest predictor of drug retention.
“We report a rather favorable 5- and 10-year TNF inhibitor survival rate in patients with SpA,” Flouri and colleagues wrote. “Patients with AS showed a higher drug retention rate compared to PsA and [undifferentiated] SpA patients. When first-year clinical responses for axial or peripheral disease were included in the multivariate models of drug survival, they were the strongest independent predictors. We thus support close disease activity monitoring as a valuable tool to predict long-term outcomes.” – by Jason Laday
Disclosure: The researchers reports grant funding from Schering-Plough, AbbVie, Pfizer, Bristol Myers Squibb, and Roche. Please see the study for all other authors’ relevant financial disclosures.
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