title: Longterm retention of tumor necrosis factor-α inhibitor therapy in a large italian cohort of patients with rheumatoid arthritis from the GISEA registry: an appraisal of predictors.
abstract: OBJECTIVE
  To evaluate 4-year retention rates of tumor necrosis factor-α (TNF-α) inhibitors adalimumab, etanercept, and infliximab among patients with longstanding rheumatoid arthritis (RA), as derived from an Italian national registry.
  
  
  METHODS
  The clinical records of 853 adult patients with RA in the GISEA (Gruppo Italiano Studio Early Arthritis) registry were prospectively analyzed to compare drug survival rates and the baseline factors that may predict adherence to therapy.
  
  
  RESULTS
  In 2003 and 2004, 324 patients started treatment with adalimumab, 311 with etanercept, and 218 with infliximab. After 4 years, the global retention rate of anti-TNF-α therapy was 42%. Etanercept survival (51.4%) was significantly better than that of infliximab (37.6%) or adalimumab (36.4%; p < 0.0001). Accordingly, the mean duration of therapy was significantly longer for etanercept (3.1 ± 2 yrs) than for adalimumab (2.6 ± 2 yrs) or infliximab (2.7 ± 2 yrs; p < 0.05). The use of concomitant disease-modifying antirheumatic drugs, mainly methotrexate, and the presence of comorbidities significantly predicted drug continuation (p < 0.01), whereas a high Disease Activity Score did not.
  
  
  CONCLUSIONS
  The 4-year global drug survival of adalimumab, etanercept, and infliximab was lower than 50%, with etanercept having the best retention rate. The main positive predictor of adherence to anti-TNF-α therapy was the concomitant use of methotrexate. Our study provides further evidence that the real-life treatment of patients with RA may be different from that of randomized clinical trials.
authors.affiliation: Università Cattolica del Sacro Cuore, Rome, Italy. f.iannone@reumbari.uniba.it
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
authors.forename: Fabiola
authors.initials: F
authors.lastname: Atzeni
authors.forename: Domenico
authors.initials: D
authors.lastname: Biasi
authors.forename: Costantino
authors.initials: C
authors.lastname: Botsios
authors.forename: Paola
authors.initials: P
authors.lastname: Cipriani
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
authors.forename: Valentina
authors.initials: V
authors.lastname: Foschi
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Gerli
authors.forename: Annarita
authors.initials: A
authors.lastname: Giardina
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.forename: Tamara
authors.initials: T
authors.lastname: Ziglioli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lapadula
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000633:toxicity*; D018771:Arthralgia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D057915:Drug Substitution / Q000706:statistics & numerical data; D000068800:Etanercept; D005260:Female; D006304:Health Status; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D007558:Italy; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012042:Registries; D015996:Survival Rate; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D015415:Biomarkers; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept