title: Rate and causes of infliximab discontinuation in patients with rheumatoid arthritis in a private clinical practice.
abstract: 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.
authors.affiliation: Centro Reumatológico Strusberg, Córdoba, Argentina. anabertoli@yahoo.com
authors.forename: Ana M
authors.initials: AM
authors.lastname: Bertoli
authors.forename: Ingrid
authors.initials: I
authors.lastname: Strusberg
authors.forename: Marcos
authors.initials: M
authors.lastname: Baravalle
authors.forename: Zulma
authors.initials: Z
authors.lastname: Betelu
authors.forename: Diego
authors.initials: D
authors.lastname: Calás
authors.forename: Liliana
authors.initials: L
authors.lastname: Morales
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Strusberg
mesh_terms: 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*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab