Direct Comparison of Treatment Responses, Remission Rates, and Drug Adherence in Patients With Rheumatoid Arthritis Treated With Adalimumab, Etanercept, or Infliximab Results From Eight Years of Surveillance of Clinical Practice in the Nationwide Danish DANBIO Registry

被引:447
作者
Hetland, Merete Lund [1 ,2 ,3 ]
Christensen, Ib Jarle [4 ]
Tarp, Ulrik [5 ]
Dreyer, Lene
Hansen, Annette [6 ,7 ]
Hansen, Ib Tonder [8 ]
Kollerup, Gina [9 ]
Linde, Louise [2 ,3 ]
Lindegaard, Hanne M. [10 ]
Poulsen, Uta Engling [11 ]
Schlemmer, Annette [12 ]
Jensen, Dorte Vendelbo [13 ]
Jensen, Signe [6 ]
Hostenkamp, Gisela [14 ]
Ostergaard, Mikkel [3 ,6 ]
机构
[1] Copenhagen Univ Hosp, Dept Rheumatol 232, DANBIO, DK-2650 Hvidovre, Denmark
[2] DANBIO Registry, Hvidovre, Denmark
[3] Copenhagen Univ Hosp, Glostrup, Denmark
[4] Copenhagen Univ Hosp, Finsen Lab, Rigshosp, Copenhagen, Denmark
[5] Aarhus Univ Hosp, DK-8000 Aarhus, Denmark
[6] Copenhagen Univ Hosp, Gentofte, Denmark
[7] DANBIO Registry, Gentofte, Denmark
[8] Viborg Hosp, Viborg, Denmark
[9] Copenhagen Univ Hosp, Bispebjerg, Denmark
[10] Odense Univ Hosp, DK-5000 Odense, Denmark
[11] Univ So Denmark, Rheumatism Hosp, Grasten, Denmark
[12] Aarhus Univ Hosp, Aalborg, Denmark
[13] Horsholm Hosp, Horsholm, Denmark
[14] Inst Publ Hlth, Hlth Econ Unit, Odense, Denmark
来源
ARTHRITIS AND RHEUMATISM | 2010年 / 62卷 / 01期
关键词
COLLEGE-OF-RHEUMATOLOGY; ANTI-TNF; PRESCRIPTION PRACTICE; BIOLOGICAL AGENTS; THERAPY; METHOTREXATE; EFFICACY; COMBINATION; CRITERIA; CONTINUATION;
D O I
10.1002/art.27227
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To compare tumor necrosis factor alpha inhibitors directly regarding the rates of treatment response, remission, and the drug survival rate in patients with rheumatoid arthritis (RA), and to identify clinical prognostic factors for response. Methods. The nationwide DANBIO registry collects data on rheumatology patients receiving routine care. For the present study, we included patients from DANBIO who had RA (n = 2,326) in whom the first biologic treatment was initiated (29% received adalimumab, 22% received etanercept, and 49% received infliximab). Baseline predictors of treatment response were identified. The odds ratios (ORs) for clinical responses and remission and hazard ratios (HRs) for drug withdrawal were calculated, corrected for age, disease duration, the Disease Activity Score in 28 joints (DAS28), seropositivity, concomitant methotrexate and prednisolone, number of previous disease-modifying drugs, center, and functional status (Health Assessment Questionnaire score). Results. Seventy percent improvement according to the American College of Rheumatology criteria (an ACR70 response) was achieved in 19% of patients after 6 months. Older age, concomitant prednisolone treatment, and low functional status at baseline were negative predictors. The ORs (95% confidence intervals [ 95% CIs]) for an ACR70 response were 2.05 (95% CI 1.52-2.76) for adalimumab versus infliximab, 1.78 (95% CI 1.28-2.50) for etanercept versus infliximab, and 1.15 (95% CI 0.82-1.60) for adalimumab versus etanercept. Similar predictors and ORs were observed for a good response according to the European League Against Rheumatism criteria, DAS28 remission, and Clinical Disease Activity Index remission. At 48 months, the HRs for drug withdrawal were 1.98 for infliximab versus etanercept (95% 1.63-2.40), 1.35 for infliximab versus adalimumab (95% CI 1.15-1.58), and 1.47 for adalimumab versus etanercept (95% CI 1.20-1.80). Conclusion. Older age, low functional status, and concomitant prednisolone treatment were negative predictors of a clinical response and remission. Infliximab had the lowest rates of treatment response, disease remission, and drug adherence, adalimumab had the highest rates of treatment response and disease remission, and etanercept had the longest drug survival rates. These findings were consistent after correction for con-founders and sensitivity analyses and across outcome measures and followup times.
引用
收藏
页码:22 / 32
页数:11
相关论文
共 30 条
[1]   Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score [J].
Aletaha, D ;
Nell, VP ;
Stamm, T ;
Uffmann, M ;
Pflugbeil, S ;
Machold, K ;
Smolen, JS .
ARTHRITIS RESEARCH & THERAPY, 2005, 7 (04) :R796-R806
[2]   TNFα antagonist continuation rates in 442 patients with inflammatory joint disease [J].
Brocq, Olivier ;
Roux, Christian Hubert ;
Albert, Christine ;
Breuil, Veronique ;
Aknouche, Nicolas ;
Ruitord, Sandra ;
Mousnier, Aline ;
Euller-Ziegler, Liana .
JOINT BONE SPINE, 2007, 74 (02) :148-154
[3]   Long-term infliximab treatment in rheumatoid arthritis: subsequent outcome of initial responders [J].
Buch, M. H. ;
Bingham, S. J. ;
Bryer, D. ;
Emery, P. .
RHEUMATOLOGY, 2007, 46 (07) :1153-1156
[4]  
D'Agostino RB, 1998, STAT MED, V17, P2265, DOI 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO
[5]  
2-B
[6]   Systematic review: Comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis [J].
Donahue, Katrina E. ;
Gartlehner, Gerald ;
Jonas, Daniel E. ;
Lux, Linda J. ;
Thieda, Patricia ;
Jonas, Beth L. ;
Hansen, Richard A. ;
Morgan, Laura C. ;
Lohr, Kathleen N. .
ANNALS OF INTERNAL MEDICINE, 2008, 148 (02) :124-134
[7]   AMERICAN-COLLEGE-OF-RHEUMATOLOGY PRELIMINARY DEFINITION OF IMPROVEMENT IN RHEUMATOID-ARTHRITIS [J].
FELSON, DT ;
ANDERSON, JJ ;
BOERS, M ;
BOMBARDIER, C ;
FURST, D ;
GOLDSMITH, C ;
KATZ, LM ;
LIGHTFOOT, R ;
PAULUS, H ;
STRAND, V ;
TUGWELL, P ;
WEINBLATT, M ;
WILLIAMS, HJ ;
WOLFE, F ;
KIESZAK, S .
ARTHRITIS AND RHEUMATISM, 1995, 38 (06) :727-735
[8]  
Gartlehner G, 2006, J RHEUMATOL, V33, P2398
[9]   Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden [J].
Geborek, P ;
Crnkic, M ;
Petersson, IF ;
Saxne, T .
ANNALS OF THE RHEUMATIC DISEASES, 2002, 61 (09) :793-798
[10]   Do changes in prescription practice in patients with rheumatoid arthritis treated with biological agents affect treatment response and adherence to therapy? Results from the nationwide Danish DANBIO Registry [J].
Hetland, M. L. ;
Lindegaard, H. M. ;
Hansen, A. ;
Podenphant, J. ;
Unkerskov, J. ;
Ringsdal, V. S. ;
Ostergaard, M. ;
Tarp, U. .
ANNALS OF THE RHEUMATIC DISEASES, 2008, 67 (07) :1023-1026