Rate and Causes of Infliximab Discontinuation in Patients With Rheumatoid Arthritis in a Private Clinical Practice

Objectives: To describe the rate of infliximab discontinuation and the causes of this event in a population of rheumatoid arthritis patients. Patients and Methods: Rheumatoid arthritis patients from an outpatient private center treated with infliximab (at least 2 consecutive doses) were retrospectively studied. The infliximab discontinuation rate was examined by the Kaplan-Meier survival method. Variables associated with infliximab discontinuation were analyzed by univariable and multivariable Cox proportional hazards regression analyses. Results: Seventy-seven patients treated with infliximab between August 2000 and December 2006 were identified; of them, 33 (43%) discontinued this drug. The cumulative discontinuation rate was of 23%, 35%, and 43% at 12, 24, and 36 months, respectively. Causes of discontinuation were drug-related adverse reactions (41 %), financial constraints (15%), lack of efficacy (12%), and others (32%). Variables independently associated with infliximab discontinuation were the number of tender joints on an average during infliximab treatment [hazard ratio (HR) = 1.17, 95% confidence interval (Cl) 1.05-1.3 1; P = 0.005] and the occurrence of any adverse reaction attributed to infliximab (HR = 2.86, 95% Cl 1.37-7.19; P, = 0.026), whereas having full pharmacy coverage for infliximab (HR = 0.32, 95% Cl 0. 13-0.79, P = 0.014) was protective. Conclusion: Forty-three percent of patients discontinued infliximab at 3 years; most of them because of adverse reactions and financial constraints. Rheumatologists should be aware that those patients with more active disease were also at higher risk of discontinuing inflixiimab.