Rate and causes of infliximab discontinuation in patients with rheumatoid arthritis in a private clinical practice.
OBJECTIVE
To describe the rate of infliximab discontinuation and the causes of this event in a population of rheumatoid arthritis patients.


METHODS
Rheumatoid arthritis patients from an out-patient 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 (CI) 1.05-1.31; P = 0.005] and the occurrence of any adverse reaction attributed to infliximab (HR = 2.86, 95% CI 1.37-7.19; P = 0.026), whereas having full pharmacy coverage for infliximab (HR = 0.32, 95% CI 0.13-0.79, P = 0.014) was protective.


CONCLUSIONS
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 infliximab.
Bertoli
Ana M
AM
Centro Reumatológico Strusberg, Córdoba, Argentina. anabertoli@yahoo.com
Strusberg
Ingrid
I
Baravalle
Marcos
M
Betelu
Zulma
Z
Calás
Diego
D
Morales
Liliana
L
Strusberg
Alberto M
AM
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000191:economics; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics; D001118:Argentina; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D015510:Clinical Medicine / Q000706:statistics & numerical data*; D000075202:Contraindications; D005260:Female; D017048:Health Care Costs; D006801:Humans; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab