title: Drug survival of the first course of anti-TNF agents in patients with rheumatoid arthritis and seronegative spondyloarthritis: analysis from the MonitorNet database.
abstract: OBJECTIVE
  To compare drug survival of different anti-TNF drugs (infliximab, INF, etanercept, ETA, and adalimumab, ADA) in rheumatoid arthritis (RA) and spondyloarthritis (SpA) by analysing data collected from an Italian multicenter observational cohort study.
  
  
  METHODS
  All patients with RA or SpA registered in the MonitorNet database who started their first course of anti-TNF therapy were included. Overall drug survival was measured, along with specific reasons of discontinuation (inefficacy or adverse events). A first set of analyses using RA as reference category assessed the relationship between diagnosis and drug survival. A second set of analyses stratified by diagnosis (RA and SpA) used INF as reference drug. Adjustment for confounders was performed. The results are presented as adjusted hazard ratios (adjHR) and 95% confidence intervals (95%CI).
  
  
  RESULTS
  2640 RA patients and 1220 SpA patients with a median follow-up of 17 months (IQR 7.2-33.4) were included in the analyses. Patients with a diagnosis of SpA showed a lower risk of drug discontinuation with an adjHR (95%CI) of 0.81 (0.73, 0.90). In SpA, the subset of patients with ankylosing spondylitis (AS) showed the best survival on treatment. In RA, both ETA and ADA showed a significantly lower probability of withdrawal when compared to INF [adjHR (95%CI) 0.46 (0.38, 0.56) and 0.68 (0.57, 0.81), respectively]. Similar results were found in SpA.
  
  
  CONCLUSIONS
  Drug survival for SpA is longer than that in RA mainly due to the AS subgroup. In both RA and SpA, ETA and ADA showed a better retention on treatment when compared to INF.
authors: Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy. c.scire@reumatologia.it.
authors: Carlo A
authors: CA
authors: Scirè
authors: Roberto
authors: R
authors: Caporali
authors: Piercarlo
authors: P
authors: Sarzi-Puttini
authors: Bruno
authors: B
authors: Frediani
authors: Manuela
authors: M
authors: Di Franco
authors: Angela
authors: A
authors: Tincani
authors: Luigi
authors: L
authors: Sinigaglia
authors: Paolo
authors: P
authors: Sfriso
authors: Rosella
authors: R
authors: Tirri
authors: Emanuela
authors: E
authors: Bellis
authors: Giovanni
authors: G
authors: Delsante
authors: Giovanni
authors: G
authors: Porru
authors: Fausto
authors: F
authors: Salaffi
authors: Dilia
authors: D
authors: Giuggioli
authors: Maurizio
authors: M
authors: Rossini
authors: Monica
authors: M
authors: Todoerti
authors: Laura
authors: L
authors: Bazzichi
authors: Marcello
authors: M
authors: Govoni
authors: Roberto
authors: R
authors: Gerli
authors: Roberto
authors: R
authors: Raschetti
authors: Giovanni
authors: G
authors: Minisola
authors: Carlomaurizio
authors: C
authors: Montecucco
authors: Silvano
authors: S
authors: Todesco
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D025241:Spondylarthritis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha