title: Comparative Effectiveness of Etanercept and Adalimumab in Patient Reported Outcomes and Injection-Related Tolerability.
abstract: OBJECTIVE
  To describe patient preferences in selecting specific biologics and compare clinical response using patient reported outcomes (PROs) among patients with rheumatoid arthritis (RA) started on different anti-tumor necrosis factor (TNF) therapies.
  
  
  METHODS
  Participants were enrollees in Kaiser Permanente Northern California. Patients with RA who had at least two provider visits and started a new anti-TNF therapy from 10/2010-8/2011, were eligible for participation in this longitudinal study. Using a telephone survey, patient preferences in biologic selection and RAPID3, MDHAQ, and SF-12 scores were collected at baseline and at 6 months. Patient scores rating injection/infusion-site burning and stinging (ISBS) were collected at 6 months.
  
  
  RESULTS
  In all, 267 patients with RA responded to the baseline survey, of whom 57% preferred an injectable biologic, 22% preferred an infused biologic, and 21% had no preference. Motivation for injectable biologics was convenience (92%) and for infusion therapy was dislike or lack of self-efficacy for self-injection (16%). After 6 months of treatment with anti-TNF, 70% of the 177 patients who answered the ISBS question reported ISBS with the last dose; on a scale of 1 (none) to 10 (worst), 41% of these reported a score of 2-5; and 29% reported a score of 6-10. Adalimumab users experienced 3.2 times (95% confidence interval 1.2-8.6) the level of ISBS that etanercept users experienced. There were no significant differences in RAPID3, MDHAQ, or SF-12 scores between etanercept or adalimumab initiators.
  
  
  CONCLUSIONS
  Convenience and fear of self-injection were important considerations to patients selecting a biologic drug. Although more convenient, adalimumab associated with more ISBS than did etanercept, and this rate was higher than reported in clinical trials. At 6 months, PROs did not differ between etanercept and adalimumab users.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Iris
authors.initials: I
authors.lastname: Navarro-Millán
authors.affiliation: Kaiser Permanente, Northern California, San Francisco, California, United States of America.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Lang
authors.initials: L
authors.lastname: Chen
authors.affiliation: University of Massachusetts, Worcester, Massachusetts, United States of America.
authors.forename: Leslie
authors.initials: L
authors.lastname: Harrold
authors.affiliation: Kaiser Permanente, Northern California, San Francisco, California, United States of America.
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000648:ultrastructure; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001688:Biological Products / Q000627:therapeutic use; D002140:California; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept