title: Comparative effectiveness and predictors of response to tumour necrosis factor inhibitor therapies in rheumatoid arthritis.
abstract: OBJECTIVE
  Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort.
  
  
  METHODS
  Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified.
  
  
  RESULTS
  The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response.
  
  
  CONCLUSIONS
  Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab.
authors: Rheumatology Research Unit, Instituto de Medicina Molecular, Edificio Egas Moniz, Faculdade de Medicina de Lisboa, Av Egas Moniz, 1649-028 Lisbon, Portugal. helenacanhao@netcabo.pt
authors: Helena
authors: H
authors: Canhão
authors: Ana Maria
authors: AM
authors: Rodrigues
authors: Ana Filipa
authors: AF
authors: Mourão
authors: Fernando
authors: F
authors: Martins
authors: Maria José
authors: MJ
authors: Santos
authors: José
authors: J
authors: Canas-Silva
authors: Joaquim
authors: J
authors: Polido-Pereira
authors: José Alberto
authors: JA
authors: Pereira Silva
authors: José António
authors: JA
authors: Costa
authors: Domingos
authors: D
authors: Araújo
authors: Cândida
authors: C
authors: Silva
authors: Helena
authors: H
authors: Santos
authors: Cátia
authors: C
authors: Duarte
authors: José Antonio Pereira
authors: JA
authors: da Silva
authors: Fernando M
authors: FM
authors: Pimentel-Santos
authors: Jaime Cunha
authors: JC
authors: Branco
authors: Elizabeth W
authors: EW
authors: Karlson
authors: João Eurico
authors: JE
authors: Fonseca
authors: Daniel H
authors: DH
authors: Solomon
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000704:Analysis of Variance; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept