Retention rates of adalimumab, etanercept and infliximab as first and second-line biotherapy in patients with rheumatoid arthritis in daily practice.
OBJECTIVE
To compare retention rates of adalimumab, etanercept and infliximab as first-line biotherapy in rheumatoid arthritis (RA), to determine causes of discontinuation, retention-associated factors, and retention rates of possible second-line TNF-α inhibitors (TNFi).


METHODS
In this retrolective, multicentric study, medical charts of RA patients starting TNFi between March 2005 and April 2009 were reviewed, with follow-up between two and six years. The retention rate was estimated using the Kaplan-Meier method. Comparison between TNFi was done after adjustment using a Cox model. Factors associated with better retention were identified by multivariate analysis.


RESULTS
Of the 706 patients included, the percentage continuing treatment after two years was 54.9, 61.9 and 48.7%, and the median retention was 31, 45 and 23 months for adalimumab, etanercept and infliximab, respectively. The hazard ratios (HRs) for discontinuation were greater with adalimumab and infliximab than etanercept (1.315, 95% CI [1.050-1.648] and 1.380, 95% CI [1.041-1.828], respectively). The HR for discontinuation due to inefficacy was significantly higher with adalimumab than etanercept. Adverse events were significantly higher with infliximab than etanercept. Past use of more DMARDs and higher baseline ESR were associated with better retention. The median retention of the second-line TNFi was 11, 43 and 19.1 months for adalimumab, etanercept, and infliximab, respectively. HRs for adalimumab discontinuation due to all causes were significantly greater than for etanercept.


CONCLUSIONS
Etanercept had a better retention rate than adalimumab and infliximab as first-line biotherapy in RA, and than adalimumab as second-line biotherapy.
Fédération de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
Aline
A
Frazier-Mironer
Rheumatology B Department, Paris-Descartes University, AP-HP, Cochin Hospital, 27, rue du faubourg Saint-Jacques, 75014 Paris, France.
Maxime
M
Dougados
Rheumatology, université Paris-Sud, hôpitaux universitaires Paris-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France.
Xavier
X
Mariette
Dept of Rheumatology, hôpital Purpan, place du Dr-Baylac, Toulouse cedex 9, France.
Alain
A
Cantagrel
Pfizer France, 23-25, avenue du Docteur-Lannelongue, 75014 Paris, France.
Véronique
V
Deschamps
Rheumatology Department, Lille 2 University, hopital R-Salengro, CHRU, 2, rue Émile-Laine, 59037 Lille cedex, France.
René Marc
RM
Flipo
Pfizer France, 23-25, avenue du Docteur-Lannelongue, 75014 Paris, France.
Isabelle
I
Logeart
Service de rhumatologie, groupe hospitalier Pellegrin, 6, place Amélie-Raba-Leon, 33076 Bordeaux, France.
Thierry
T
Schaeverbeke
Service de rhumatologie, CHU de Strasbourg, hôpital Hautepierre, 67098 Strasbourg cedex, France.
Jean
J
Sibilia
Rheumatology Department, Rouen University hospital and Inserm, U 905, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Rouen, France.
Xavier
X
Le Loët
Departement de rheumatologie, hôpital Lapeyronie, 371, avenue du doyen Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: b-combe@chu-montpellier.fr.
Bernard
B
Combe
D000068879:Adalimumab; D000328:Adult; 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; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
Adalimumab; Etanercept; Infliximab; Retention rate; Rheumatoid arthritis; TNF-α inhibitors