title: Which patients with rheumatoid arthritis, spondyloarthritis, or juvenile idiopathic arthritis receive TNF-α antagonists in France? The CORPUS cohort study.
abstract: OBJECTIVE
  Limited information is available about the characteristics of patients with active inflammatory rheumatic diseases who start TNF-α antagonist therapy. Our objective was to assess TNF-α antagonist prescription patterns in this context in France.
  
  
  METHODS
  Between 2007 and 2009, 102 rheumatologists, internists, and pediatricians in French university hospitals and private practice prospectively recruited biologics-naïve patients with active rheumatoid arthritis (RA) (DAS28>3.2 despite methotrexate therapy), spondyloarthritis (SA) (BASDAI≥4 despite non-steroidal anti-inflammatory drug [NSAID] use), and juvenile idiopathic arthritis (JIA) (unresponsive to methotrexate). Patients were monitored prospectively for 1 year.
  
  
  RESULTS
  Of the 543 RA, 287 SA, and 53 JIA patients included in the study, 382 RA, 171 SA, and 28 JIA patients had complete follow-up data available after 1 year. Among these patients, 110/382 (28.8%) with RA, 81/171 (47.4%) with SA, and 26/28 (92.9%) with JIA received at least one TNF-α antagonist dose during the 1-year follow-up. The main physician-reported reason for not starting TNF-α antagonists in patients with RA or SA was low disease activity (72% for RA and 67% for SA); absence of TNF-α antagonist therapy was due to patient refusal in only 10% and to contraindications in 6% to 7% of cases.
  
  
  CONCLUSIONS
  In France, TNF-α antagonists, which are fully reimbursed by the national health insurance system, were used almost routinely in JIA patients unresponsive to methotrexate and were given to about half the SA patients with BASDAI≥4 despite NSAID use and a third of RA patients with DAS28>3.2 despite methotrexate therapy.
authors: Rheumatology Department, Cavale Blanche University Hospital, and Université Bretagne Occidentale, Brest, France.
authors: Alain
authors: A
authors: Saraux
authors: Department of Biostatistics, Rouen University Hospital and INSERM U657, Institute for Biomedical Research, University of Rouen, Rouen, France.
authors: Jacques
authors: J
authors: Benichou
authors: Department of Internal Medicine, Hôpital Cochin-Paris Univ 2, Paris, France.
authors: Loic
authors: L
authors: Guillevin
authors: Inserm, CIC-EC CIE6, CHU de Brabois, Vandoeuvre-lès-Nancy; and Inserm-Transfert, Paris, France.
authors: Latifa
authors: L
authors: Idbrik
authors: Service de Rhumatologie A, Hôpital Cochin, AP-HP, Université Paris-Descartes, Paris, France.
authors: Chantal
authors: C
authors: Job-Deslandre
authors: Service de Rhumatologie, CHU Hautepierre, Service de Rhumatologie, Strasbourg, France.
authors: Jean
authors: J
authors: Sibilia
authors: Inserm, CIC-EC 1433, CHU Nancy, Epidémiologie et Evaluation Cliniques, Nancy, France.
authors: Marc
authors: M
authors: Soudant
authors: Service de Rhumatologie, CHU de Besançon, Besançon; and EA 4266, Université de Franche-Comté, Besançon, France.
authors: Daniel
authors: D
authors: Wendling
authors: Inserm, CIC-EC 1433, CHU Nancy, Epidémiologie et Evaluation Cliniques, Nancy, France.
authors: Francis
authors: F
authors: Guillemin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D000075202:Contraindications; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D005602:France; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D012720:Severity of Illness Index; D025242:Spondylarthropathies / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha