title: Drug survival on tumour necrosis factor inhibitors in patients with rheumatoid arthritis in Finland.
abstract: OBJECTIVE
  A systematic review found that an average of 27% of rheumatoid arthritis (RA) patients using tumour necrosis factor (TNF) inhibitors discontinue their treatment within 1 year. The aim of this study was to assess drug survival on TNF inhibitors among patients with RA.
  
  
  METHODS
  Patients were identified from the National Register for Biologic Treatment in Finland (ROB-FIN), which is a longitudinal cohort study established to monitor the effectiveness and safety of biologic drugs in rheumatic diseases. Inclusion was limited to TNF-inhibitor treatments started as the patient's first, second, or third biologic treatment between 2004 and 2014. Follow-up was truncated at 36 months. The results of a time-dependent Cox proportional hazards model were reported as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Of the 4200 TNF-inhibitor treatment periods identified from ROB-FIN, 3443 periods from 2687 patients met the inclusion criteria. Twenty-seven per cent of the patients discontinued their treatment within 12 months. Infliximab (HR 1.8, 95% CI 1.3-2.5) and certolizumab pegol (HR 1.7, 95% CI 1.2-2.3) had lower drug survival compared to golimumab. A similar trend was seen with adalimumab (HR 1.2, 95% CI 0.90-1.7) and etanercept (HR 1.2, 95% CI 0.87-1.6). Concomitant use of methotrexate (MTX) was associated with improved drug survival (HR 0.76, 95% CI 0.64-0.90) in comparison with TNF-inhibitor monotherapy.
  
  
  CONCLUSIONS
  Golimumab was better in terms of drug survival than infliximab or certolizumab pegol and at least as good as adalimumab and etanercept. Concomitant use of MTX improved drug survival on TNF inhibitors.
authors.affiliation: a Faculty of Pharmacy , University of Helsinki , Helsinki , Finland.
authors.forename: K J
authors.initials: KJ
authors.lastname: Aaltonen
authors.affiliation: a Faculty of Pharmacy , University of Helsinki , Helsinki , Finland.
authors.forename: J T
authors.initials: JT
authors.lastname: Joensuu
authors.affiliation: b Department of Medicine , Turku University Hospital , Turku , Finland.
authors.forename: L
authors.initials: L
authors.lastname: Pirilä
authors.affiliation: c Department of Medicine , Lahti Central Hospital , Lahti , Finland.|d Faculty of Medicine , University of Tampere , Tampere , Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kauppi
authors.affiliation: e Department of Medicine , Lapland Central Hospital , Rovaniemi , Finland.
authors.forename: T
authors.initials: T
authors.lastname: Uutela
authors.affiliation: f Department of Medicine , Tampere City Hospital , Tampere , Finland.
authors.forename: T
authors.initials: T
authors.lastname: Varjolahti-Lehtinen
authors.affiliation: g Department of Medicine , Satakunta Central Hospital , Rauma , Finland.
authors.forename: T
authors.initials: T
authors.lastname: Yli-Kerttula
authors.affiliation: d Faculty of Medicine , University of Tampere , Tampere , Finland.|h Department of Medicine , Tampere University Hospital , Tampere , Finland.
authors.forename: P
authors.initials: P
authors.lastname: Isomäki
authors.affiliation: i Department of Medicine , Helsinki University Hospital , Helsinki , Finland.|j Faculty of Medicine, Clinicum , University of Helsinki , Helsinki , Finland.
authors.forename: D
authors.initials: D
authors.lastname: Nordström
authors.affiliation: k Department of Medicine , Jyväskylä Central Hospital , Jyväskylä , Finland.|l Faculty of Health Science , University of Eastern Finland , Kuopio , Finland.
authors.forename: T
authors.initials: T
authors.lastname: Sokka
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology; D016903:Drug Monitoring / Q000379:methods / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate