title: Direct Comparative Effectiveness Among 3 Anti-Tumor Necrosis Factor Biologics in a Real-Life Cohort of Patients With Rheumatoid Arthritis.
abstract: OBJECTIVE
  This study aimed to compare the clinical response at 36 months and evaluate the adverse events in a cohort of patients with rheumatoid arthritis treated with etanercept, infliximab, or adalimumab.
  
  
  METHODS
  An observational retrospective cohort study was performed. Patients older than 18 years with active rheumatoid arthritis, for which the physician had initiated a treatment scheme with etanercept, infliximab, or adalimumab, were included in the study. The follow-up was conducted through at least trimestral evaluations during the course of 36 months. Outcomes evaluated included Disease Activity Score 28, level of disease activity, Health Assessment Questionnaire, and degree of disability.
  
  
  RESULTS
  Three hundred seven subjects were included in the cohort (108 adalimumab, 107 infliximab, and 92 etanercept). The median Disease Activity Score 28 at the onset was 4.1 and 2.39 at month 36. There were no differences among the 3 medications (P = 0.51). The remission rate was of 7.4 per 100 people per month (95% confidence interval [CI], 6.6-8.3) without differences between groups. The initial Health Assessment Questionnaire median was 1.75 and 0.25 at 36 months. No differences per medicine were found (P = 0.54). The most common adverse effect was dermatitis. Eighteen cases of serious adverse effects occurred, including 11 cases of serious infectious events. The adverse events rates were as follows: infliximab, 24 per 100 people per year (95% CI, 19-29); adalimumab, 22 per 100 people per year (95% CI, 18-27); and etanercept, 12 per 100 people per year (95% CI, 8-16).
  
  
  CONCLUSIONS
  Etanercept, infliximab, and adalimumab are 3 effective therapeutic anti-tumor necrosis factor alternatives to reduce the level of severity and the degree of disability generated by rheumatoid arthritis. Etanercept presented a rate of adverse events lower than those for infliximab and adalimumab.
authors.affiliation: From the *BIOMAB IPS, Rheumatoid Arthritis Center; and †SIIES Research and Education in Health, Bogotá-Colombia.
authors.forename: Pedro
authors.initials: P
authors.lastname: Santos-Moreno
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sánchez
authors.forename: Danny
authors.initials: D
authors.lastname: Gómez
authors.forename: Juan
authors.initials: J
authors.lastname: Bello-Gualtero
authors.forename: Carlos
authors.initials: C
authors.lastname: Castro
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D000068800:Etanercept / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept