title: Discontinuation rates of biologics in patients with rheumatoid arthritis: are TNF inhibitors different from non-TNF inhibitors?
abstract: OBJECTIVE
  To compare discontinuation rates of first and second biologics in rheumatoid arthritis (RA) by tumour-necrosis factor inhibitor (TNFi) status and identify predictors and reasons for discontinuation.
  
  
  METHODS
  From 1998 to 2011, self-reported medication use for RA was assessed every 6 months via questionnaire in a longitudinal study in the USA. Time-on-drug analyses were conducted for individual biologics and groups, and annual rates reported. Time to discontinuation of TNFi and non-TNFi was compared, unadjusted and adjusted using propensity score analyses. Baseline and time-varying predictors of biologic discontinuation were derived through Cox regression.
  
  
  RESULTS
  Of 2281 patients initiating their first biologic, 1100 (48%) discontinued and of 1097 initiating a second biologic, 537 (49%) discontinued. The annual discontinuation rate was 17% (median 4 years) for first biologic and 20% (median 3.3 years) for second biologic. TNFi had lower discontinuation rates than non-TNFi after propensity score adjustment: HR for first biologic 0.49 (0.34 to 0.71) and 0.68 (0.51 to 0.90) for second biologic. The annual discontinuation rate was significantly lower in patients starting their first biologic before January 2005 vs after (16 vs 25%, p=0.005). Predictors of discontinuation for the first biologic included smoking, higher comorbidity index, worse overall health and not using concomitant methotrexate.
  
  
  CONCLUSIONS
  In this large cohort, patients with RA tended to remain on their first and second biologics for relatively long periods suggesting the drugs' effectiveness. Discontinuation rates were lower in patients using TNFi, and all rates increased after January 2005 when the number of biologics available increased.
authors.affiliation: Department of Clinical Immunology & Rheumatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ; Department of Rheumatology , Hospital Garcia de Orta , Almada , Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Department of Clinical Immunology & Rheumatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ; Department of Rheumatology , Atrium Medical Center , Heerlen , The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Amgen Inc. , Thousand Oaks, California , USA.
authors.forename: David
authors.initials: D
authors.lastname: Harrison
authors.affiliation: Amgen Inc. , Thousand Oaks, California , USA.
authors.forename: David
authors.initials: D
authors.lastname: Collier
authors.affiliation: National Data Bank for Rheumatic Diseases , Wichita, Kansas , USA ; University of Nebraska Medical Center , Omaha, Nebraska , USA.
authors.forename: Kaleb
authors.initials: K
authors.lastname: Michaud
keywords: Anti-TNF; DMARDs (biologic); Outcomes research; Rheumatoid Arthritis