title: Reasons for Discontinuation and Adverse Effects of TNFα Inhibitors in a Cohort of Patients With Rheumatoid Arthritis and Ankylosing Spondylitis.
abstract: BACKGROUND
  The introduction of anti-tumor necrosis factor α (anti-TNFα) drugs has improved the clinical outcomes in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). However, these drugs may cause adverse effects that motivate a change in or discontinuation of the treatment.
  
  
  OBJECTIVE
  To evaluate the causes of discontinuation or changes in the dosage regimen in a cohort of patients with RA and AS treated with infliximab, adalimumab, etanercept, and golimumab under clinical practice conditions.
  
  
  METHODS
  This was a retrospective observational study that included patients with RA or AS treated with anti-TNFα drugs between 2008 and 2013. Changes in the dosage regimen, reasons for treatment discontinuation, and adverse effects were recorded and analyzed. Time to discontinuation was estimated using Kaplan-Meier survival analysis.
  
  
  RESULTS
  A total of 123 patients with RA and 93 patients with AS were treated with anti-TNFα therapy. During the study, 55.3% of RA patients and 41.7% of AS patients had stopped the treatment. The most frequent changes were modifications in the dosing, and the most frequent adverse effects were reactions after the infusion or injection (53.8% and 66.7% in RA and AS, respectively). Drug survival of etanercept in RA (67.9%) is greater than for adalimumab and infliximab, whereas drug survival of infliximab in AS (70.0%) is greater than for etanercept and adalimumab at 5 years, although there were no significant differences ( P = 0.098 in RA and 0.194 in AS).
  
  
  CONCLUSIONS
  The main cause of discontinuation of anti-TNFα is therapeutic failure in both diseases. Etanercept and infliximab have the best survival rates in RA and AS, respectively.
authors.affiliation: 1 Department of Hospital Pharmacy, Santa Lucía General University Hospital (HGUSL), Cartagena, Spain.
authors.forename: María Henar
authors.initials: MH
authors.lastname: García-Lagunar
authors.affiliation: 1 Department of Hospital Pharmacy, Santa Lucía General University Hospital (HGUSL), Cartagena, Spain.
authors.forename: María Rocío
authors.initials: MR
authors.lastname: Gutiérrez-Cívicos
authors.affiliation: 1 Department of Hospital Pharmacy, Santa Lucía General University Hospital (HGUSL), Cartagena, Spain.
authors.forename: María Sergia
authors.initials: MS
authors.lastname: García-Simón
authors.affiliation: 2 Department of Clinical Analysis, HGUSL, Cartagena, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Conesa-Zamora
authors.affiliation: 2 Department of Clinical Analysis, HGUSL, Cartagena, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Jimenez-Santos
authors.affiliation: 3 Department of Cardiology, HGUSL, Cartagena, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cano-Vivar
authors.affiliation: 1 Department of Hospital Pharmacy, Santa Lucía General University Hospital (HGUSL), Cartagena, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: García-Márquez
authors.affiliation: 1 Department of Hospital Pharmacy, Santa Lucía General University Hospital (HGUSL), Cartagena, Spain.
authors.forename: Iris
authors.initials: I
authors.lastname: Muñoz-García
authors.affiliation: 1 Department of Hospital Pharmacy, Santa Lucía General University Hospital (HGUSL), Cartagena, Spain.
authors.forename: Alice Charlotte
authors.initials: AC
authors.lastname: Viney
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004363:Drug Utilization / Q000639:trends*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D000068800:Etanercept / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: adverse drug reactions; alcohol intoxication; drug utilization; rheumatology; therapeutic monitoring