title: Drug survival and causes of discontinuation of the first anti-TNF in ankylosing spondylitis compared with rheumatoid arthritis: analysis from BIOBADABRASIL.
abstract: Treatment survival with biological therapy may be influenced by many factors, and it seems to be different among various rheumatic diseases and biological agents. The goal of the study was to compare the drug survival and the causes of discontinuation of anti-tumoral necrosis factor (anti-TNF) therapy in ankylosing spondylitis (AS) with rheumatoid arthritis (RA). Study participants were a cohort from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (BIOBADABRASIL) between 2008 and 2012. The observation time was up to 4 years following the introduction of the first treatment. Gender, age, disease duration, disease activity, comorbidities, and concomitant therapies were assessed. A total of 1303 patients were included: 372 had AS and 931 had RA in which 38.7 % (n = 504) used infliximab (IFX), 34.9 % (n = 455) used adalimumab (ADA), and 26.4 % (n = 344) used etanercept (ETA). The anti-TNF drug survival of patients with AS was 63.08 months (confidence interval (CI) 60.24, 65.92) and patients with RA was 47.5 months (CI 45.65, 49.36). It was significant higher in AS (log-rank; p ≤ 0.001). Patients with RA discontinued anti-TNF more than patients with AS when adjusted to gender and corticosteroid. The adjHR (95 % CI) was 1.6 (1.14, 2.31). Female patients who were also corticosteroid users, but not of advanced age, have shown lower survival for both diseases (log-rank, p ≤ 0.001). The discontinuation rate of IFX, but not of ADA or ETA, was significantly higher in RA than in SA; HR (95 % CI) was 2.49 (1.46, 4.24). The main causes of discontinuation were ineffectiveness and adverse event in both diseases. AS patients have better drug survival adjusted to gender, age, and corticosteroid. This results appear to be related to the disease mechanism.
authors: Rheumatology Division, University Hospital Cassiano Antônio de Moraes, Medicine Department, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1460, Departamento de Clínica Médica, CEP 29040-090, Vitória, Espírito Santo, Brazil.
authors: Bárbara P
authors: BP
authors: Fafá
authors: Paulo
authors: P
authors: Louzada-Junior
authors: David C
authors: DC
authors: Titton
authors: Eliana
authors: E
authors: Zandonade
authors: Roberto
authors: R
authors: Ranza
authors: Ieda
authors: I
authors: Laurindo
authors: Paula
authors: P
authors: Peçanha
authors: Aline
authors: A
authors: Ranzolin
authors: André L
authors: AL
authors: Hayata
authors: Angela
authors: A
authors: Duarte
authors: Inês G
authors: IG
authors: Silveira
authors: Izaias
authors: I
authors: Costa
authors: José C
authors: JC
authors: Macieira
authors: Luiz S
authors: LS
authors: Guedes-Barbosa
authors: Manoel B
authors: MB
authors: Bertolo
authors: Maria Fátima Lobato da C
authors: MF
authors: Sauma
authors: Marília B G
authors: MB
authors: Silva
authors: Marlene
authors: M
authors: Freire
authors: Morton A
authors: MA
authors: Scheinberg
authors: Vander
authors: V
authors: Fernandes
authors: Washington
authors: W
authors: Bianchi
authors: José R S
authors: JR
authors: Miranda
authors: Geraldo R C
authors: GR
authors: Pinheiro
authors: Hellen M S
authors: HM
authors: Carvalho
authors: Claiton Viegas
authors: CV
authors: Brenol
authors: Ivanio A
authors: IA
authors: Pereira
authors: Gláucio Ricardo Werner
authors: GR
authors: de Castro
authors: Júlio C Bertacini
authors: JC
authors: de Morais
authors: Sheila K F
authors: SK
authors: Oliveira
authors: Mirhelen Mendes
authors: MM
authors: de Abreu
authors: Roberto A
authors: RA
authors: Toledo
authors: Marcelo M
authors: MM
authors: Pinheiro
authors: Walber Pinto
authors: WP
authors: Vieira
authors: Valéria
authors: V
authors: Valim
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001938:Brazil; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept