Median survival of first-line TNF inhibitor in ankylosing spondylitis nearly 11 years
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Key takeaways:
- The median survival time of first-line anti-TNF therapy in ankylosing spondylitis was 10.6 years.
- The most common reason for discontinuation was inefficacy, cited by 34.9% of those who stopped.
Patients with ankylosing spondylitis starting their first TNF inhibitor, and who stayed on said treatment for at least 2 years, demonstrated a median drug survival period of 10.6 years, with 24% discontinuing, according to data.
The researchers, who published their findings in BMC Rheumatology, added that although TNF inhibitors for AS show “favorable” long-term retention, the reasons for their discontinuation vary by drug and reveal multiple treatment complexities.
“Measuring drug persistence (also referred to as drug survival), the time from treatment initiation to discontinuation, offers essential insights into their safety and effectiveness,” Bora Nam, of the department of rheumatology at the Hanyang University Hospital for Rheumatic Diseases, in South Korea, and colleagues wrote.
“It is crucial to acknowledge that reasons for discontinuation of anti-TNF agent treatment can vary between short-term and long-term treatment periods,” they added. “Recognizing the clinical differences between discontinuations due to clinical remission and those due to lack of efficacy, it becomes evident that a deeper investigation into the causes of discontinuation is necessary, rather than focusing solely on the retention rate.”
To examine the reasons for TNF-inhibitor discontinuation among patients with ankylosing spondylitis, Nam and colleagues conducted a retrospective cohort study of 429 patients with AS (median age, 32.1 years). All patients began receiving first-line adalimumab (Humira, AbbVie), etanercept (Enbrel, Amgen), infliximab (Remicade, Janssen) or golimumab (Simponi Aria, Janssen) between 2004 and 2018.
Using Cox cause-specific hazards models, the researchers estimated the chances of discontinuing different first-line anti-TNF treatments due to either clinical remission, loss of efficacy, adverse events or other reasons, such as loss to follow-up or cost.
Overall, the median survival time of first-line anti-TNF therapy was 10.6 years, with 24% of participants discontinuing during the study. According to the researchers, the most common reason for discontinuation was inefficacy (34.9%), followed by clinical remission (30.1%) and adverse events (14.6%). The remaining 20.4% of participants who discontinued cited “other reasons.”
Compared with patients treated with adalimumab, those who received etanercept were less likely to discontinue due to clinical remission (HR = 0.45; 95% CI, 0.21-0.99), and those on infliximab were more likely to discontinue due to loss of efficacy (HR = 4.53; 95% CI, 1.45-14.16). Higher score on the Bath Ankylosing Spondylitis Disease Activity Index also correlated with greater risk for discontinuation for patients on infliximab due to inefficacy (HR = 1.31; 95% CI, 1.04-1.65) vs. adalimumab use.
Meanwhile, discontinuation due to infection-related adverse events was more likely among older participants (HR = 1.07; 95% CI, 1.02-1.12), and being a current smoker was influential in discontinuation for “other reasons” (HR = 6.22; 95% CI, 1.82-21.28).
“Our study of 429 patients on first-line anti-TNF treatment for at least 2 years reveals a favorable long-term treatment retention rate,” Nam and colleagues wrote. “Predictors for discontinuation differed by cause, highlighting the complexity of treatment response and emphasizing the need for personalized approaches to treatment management. Further research is warranted to uncover the underlying mechanisms behind these discontinuation patterns and to refine strategies for optimizing patient outcomes in the realm of AS treatment.”
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