Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study.
To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).



Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score.



In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08-13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59-1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68-1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment.



Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.
Universidade Nova de Lisboa, Lisbon, Portugal, and Leiden University Medical Center, Leiden, The Netherlands. alexsepriano@gmail.com.
A
A
Sepriano
Universidade Nova de Lisboa, Lisbon, Portugal, and Leiden University Medical Center, Leiden, The Netherlands.
S
S
Ramiro
Leiden University Medical Center, Leiden, The Netherlands.
D
D
van der Heijde
Lisbon Academic Medical Center, Lisbon, Portugal.
P
P
Ávila-Ribeiro
Centro Hospitalar São João, Porto, Portugal.
R
R
Fonseca
Instituto Português de Reumatologia, Lisbon, Portugal.
J
J
Borges
Hospital Garcia de Orta, Almada, Portugal.
L
L
Teixeira
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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PD
Carvalho
Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal.
M
M
Cerqueira
Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal.
J
J
Neves
Hospital Infante D. Pedro, Aveiro, Portugal.
T
T
Meirinhos
Hospital Infante D. Pedro, Aveiro, Portugal.
A
A
Barcelos
Hospital de Faro, Faro, Portugal.
G
G
Sequeira
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
M J
MJ
Salvador
Hospital Garcia de Orta, Almada, Portugal.
J
J
Canas da Silva
Instituto Português de Reumatologia, Lisbon, Portugal.
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H
Santos
Centro Hospitalar São João, Porto, Portugal.
M
M
Bernardes
Lisbon Academic Medical Center and Instituto de Medicina Molecular, Lisbon, Portugal.
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E
Vieira-Sousa
Lisbon Academic Medical Center and Instituto de Medicina Molecular, Lisbon, Portugal.
H
H
Canhão
Universidade Nova de Lisboa and Hospital de Egas Moniz-CHLO, Lisbon, Portugal.
J C
JC
Branco
Universidade Nova de Lisboa and Hospital de Egas Moniz-CHLO, Lisbon, Portugal.
F
F
Pimentel-Santos
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Atrium Medical Center, Heerlen, The Netherlands.
R
R
Landewé
D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000276:immunology; D015331:Cohort Studies; D000069340:Deprescriptions; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D025241:Spondylarthritis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D025242:Spondylarthropathies / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept