title: Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice.
abstract: OBJECTIVE
  The study aim was to determine treatment persistence rates and to identify causes of discontinuation in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients in clinical practice.
  
  
  METHODS
  Patients treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) were retrospectively included. Treatment persistence rates were analyzed by means of a stepwise logistic regression. Differences between therapy duration were assessed by means of an analysis of variance model (ANOVA), while a chi-square test was used to evaluate relationships between therapies and causes of treatment discontinuation and the administration of concomitant disease-modifying antirheumatic drugs (DMARDs) among therapies and types of disease considering completed courses of therapy versus courses that were discontinued.
  
  
  RESULTS
  268 patients received a total of 353 anti-TNF treatment courses (97 ADA, 180 ETA, and 76 INF). Comparison among therapies showed significant difference regarding the treatment persistence rates due to the contrast between ETA and INF (P = 0.0062). We observed that 84.7% of patients were still responding after 6 months of follow-up. Comparison among diseases showed that there were significant differences between PsA and AS (P = 0.0073) and PsA and PsA with predominant axial involvement (P = 0.0467) in terms of duration of the therapy, while there were no significant differences with regard to the persistence rate.
  
  
  CONCLUSIONS
  In this cohort, anti-TNF-α therapy was associated with high drug persistence rates. As in rheumatoid arthritis, switching to another anti-TNF-α agent can be an effective option when, during the treatment of AS or PsA, therapy is suspended because of inefficacy or an adverse event. Combination therapy with DMARDs was associated with a better persistence rate.
authors.affiliation: Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Fabbroni
authors.affiliation: Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy.
authors.forename: Luca
authors.identifier: 0000-0002-7352-1275
authors.initials: L
authors.lastname: Cantarini
authors.affiliation: Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy ; Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Francesco
authors.identifier: 0000-0002-8928-2520
authors.initials: F
authors.lastname: Caso
authors.affiliation: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via S. Pansini 5, 80131 Naples, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Costa
authors.affiliation: TFS Develop, Viale Parioli 12, 00197 Rome, Italy.
authors.forename: Veronica Anna
authors.initials: VA
authors.lastname: Pagano
authors.affiliation: Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Frediani
authors.affiliation: Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Manganelli
authors.affiliation: Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; 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
references.citation: J Rheumatol Suppl. 2012 Jul;89:36-8
references.pmid: 22751589
references.citation: J Rheumatol. 1994 Sep;21(9):1694-8
references.pmid: 7799351
references.citation: Clin Exp Rheumatol. 2013 Nov-Dec;31(6):857-63
references.pmid: 23981363
references.citation: Arthritis Rheum. 2013 Oct;65(10):2645-54
references.pmid: 23818109
references.citation: Reumatismo. 2013 Jul 23;65(3):105-12
references.pmid: 23884025
references.citation: Clin Rheumatol. 2014 Apr;33(4):543-7
references.pmid: 24554385
references.citation: Arthritis Res Ther. 2009;11(1):208
references.pmid: 19232062
references.citation: J Rheumatol. 2005 Nov;32(11):2183-5
references.pmid: 16265699
references.citation: Arthritis Rheum. 2007 Jan;56(1):13-20
references.pmid: 17195186
references.citation: J Rheumatol. 1994 Dec;21(12):2286-91
references.pmid: 7699630
references.citation: Clin Rheumatol. 2014 Feb;33(2):273-6
references.pmid: 23975363
references.citation: Clin Rheumatol. 2012 Apr;31(4):711-5
references.pmid: 22113824
references.citation: Arthritis Rheum. 2006 Oct 15;55(5):812-6
references.pmid: 17013842
references.citation: Ann Rheum Dis. 2003 Feb;62(2):127-32
references.pmid: 12525381
references.citation: Clin Rheumatol. 2014 Jun;33(6):833-9
references.pmid: 23959447
references.citation: Semin Arthritis Rheum. 2008 Oct;38(2):83-100
references.pmid: 18166219
references.citation: J Rheumatol Suppl. 2012 Jul;89:49-53
references.pmid: 22751592
references.citation: Ann Rheum Dis. 2008 Mar;67(3):364-9
references.pmid: 17644547
references.citation: Nat Rev Rheumatol. 2012 Apr 10;8(5):280-7
references.pmid: 22487798
references.citation: J Rheumatol. 1994 Dec;21(12):2281-5
references.pmid: 7699629
references.citation: Br J Rheumatol. 1996 Nov;35(11):1101-5
references.pmid: 8948296
references.citation: Best Pract Res Clin Rheumatol. 2010 Oct;24(5):589-604
references.pmid: 21035082
references.citation: Rheumatology (Oxford). 2010 Mar;49(3):563-70
references.pmid: 20032223
references.citation: Expert Opin Pharmacother. 2013 Dec;14(17):2311-3
references.pmid: 24067053
references.citation: Clin Rheumatol. 2015 Feb;34(2):295-9
references.pmid: 24647981
references.citation: Ann Rheum Dis. 2011 Jan;70(1):25-31
references.pmid: 21109520
references.citation: Rheumatology (Oxford). 2006 Dec;45(12):1558-65
references.pmid: 16705046
references.citation: Arthritis Rheum. 2006 Aug;54(8):2665-73
references.pmid: 16871531
references.citation: Arthritis Rheum. 1984 Apr;27(4):361-8
references.pmid: 6231933
references.citation: Eur J Intern Med. 2011 Dec;22(6):554-60
references.pmid: 22075279
references.citation: J Rheumatol. 2012 Jan;39(1):154-6
references.pmid: 22089469
references.citation: Ann Rheum Dis. 2015 Jan;74(1):65-73
references.pmid: 23999006
references.citation: J Rheumatol. 1995 Apr;22(4):680-3
references.pmid: 7791163
references.citation: Ann Rheum Dis. 2012 Jan;71(1):4-12
references.pmid: 21953336
references.citation: Arthritis Res Ther. 2006;8(3):R72
references.pmid: 16620398
references.citation: Int J Rheumatol. 2014;2014:839135
references.pmid: 24803936
references.citation: Joint Bone Spine. 2013 Mar;80(2):165-70
references.pmid: 22867975
references.citation: Rheumatology (Oxford). 2008 Nov;47(11):1726-7
references.pmid: 18782856
references.citation: Arthritis Res Ther. 2009;11(2):R52
references.pmid: 19356232
references.citation: Ann Rheum Dis. 2008 May;67(5):717-9
references.pmid: 18055476
references.citation: Rheumatology (Oxford). 2008 Jun;47(6):897-900
references.pmid: 18403400
references.citation: Arthritis Rheum. 2008 May;58(5):1324-31
references.pmid: 18438853
references.citation: Control Clin Trials. 1991 Aug;12(4 Suppl):106S-117S
references.pmid: 1663848
references.citation: Best Pract Res Clin Rheumatol. 2011 Dec;25(6):825-42
references.pmid: 22265264
references.citation: Rheumatology (Oxford). 2012 Aug;51(8):1378-87
references.pmid: 22427410
references.citation: J Clin Pharm Ther. 2013 Aug;38(4):286-93
references.pmid: 23590560
references.citation: Mol Immunol. 2014 Jan;57(1):28-37
references.pmid: 23969080
references.citation: Ann Rheum Dis. 2007 Oct;66(10):1393-7
references.pmid: 17613555