Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study.
OBJECTIVE:To compare persistence with tumor necrosis factor alpha (TNF) antagonists among rheumatoid arthritis patients in British Columbia. Treatment persistence has been suggested as a proxy for real-world therapeutic benefit and harm of treatments for chronic non-curable diseases, including rheum...
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doaj-50e2947c9adf4b68abe08ba00ce602152020-11-25T02:35:08ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0198e10519310.1371/journal.pone.0105193Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study.Anat FisherKen BassettJames M WrightM Alan BrookhartHugh FreemanColin R DormuthOBJECTIVE:To compare persistence with tumor necrosis factor alpha (TNF) antagonists among rheumatoid arthritis patients in British Columbia. Treatment persistence has been suggested as a proxy for real-world therapeutic benefit and harm of treatments for chronic non-curable diseases, including rheumatoid arthritis. We hypothesized that the different pharmacological characteristics of infliximab, adalimumab and etanercept cause statistically and clinically significant differences in persistence. METHODS:We conducted a population-based cohort study using administrative health data from the Canadian province of British Columbia. The study cohort included rheumatoid arthritis patients who initiated the first course of a TNF antagonist between 2001 and 2008. Persistence was measured as the time between first dispensing to discontinuation. Drug discontinuation was defined as a drug-free interval of 180 days or switching to another TNF antagonist, anakinra, rituximab or abatacept. Persistence was estimated and compared using survival analysis. RESULTS:The study cohort included 2,923 patients, 63% treated with etanercept. Median persistence in years (95% confidence interval) with infliximab was 3.7 (2.9-4.9), with adalimumab 3.3 (2.6-4.1) and with etanercept 3.8 (3.3-4.3). Similar risk of discontinuation was observed for the three drugs: the hazard ratio (95% confidence interval) was 0.98 (0.85-1.13) comparing infliximab with etanercept, 0.95 (0.78-1.15) comparing infliximab with adalimumab and 1.04 (0.88-1.22) comparing adalimumab with etanercept. CONCLUSIONS:Similar persistence was observed with infliximab, adalimumab and etanercept in rheumatoid arthritis patients during the first 9 years of use. If treatment persistence is a good proxy for the therapeutic benefit and harm of these drugs, then this finding suggests that the three drugs share an overall similar benefit-harm profile in rheumatoid arthritis patients.http://europepmc.org/articles/PMC4139324?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Anat Fisher Ken Bassett James M Wright M Alan Brookhart Hugh Freeman Colin R Dormuth |
spellingShingle |
Anat Fisher Ken Bassett James M Wright M Alan Brookhart Hugh Freeman Colin R Dormuth Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study. PLoS ONE |
author_facet |
Anat Fisher Ken Bassett James M Wright M Alan Brookhart Hugh Freeman Colin R Dormuth |
author_sort |
Anat Fisher |
title |
Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study. |
title_short |
Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study. |
title_full |
Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study. |
title_fullStr |
Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study. |
title_full_unstemmed |
Comparative persistence of the TNF antagonists in rheumatoid arthritis--a population-based cohort study. |
title_sort |
comparative persistence of the tnf antagonists in rheumatoid arthritis--a population-based cohort study. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2014-01-01 |
description |
OBJECTIVE:To compare persistence with tumor necrosis factor alpha (TNF) antagonists among rheumatoid arthritis patients in British Columbia. Treatment persistence has been suggested as a proxy for real-world therapeutic benefit and harm of treatments for chronic non-curable diseases, including rheumatoid arthritis. We hypothesized that the different pharmacological characteristics of infliximab, adalimumab and etanercept cause statistically and clinically significant differences in persistence. METHODS:We conducted a population-based cohort study using administrative health data from the Canadian province of British Columbia. The study cohort included rheumatoid arthritis patients who initiated the first course of a TNF antagonist between 2001 and 2008. Persistence was measured as the time between first dispensing to discontinuation. Drug discontinuation was defined as a drug-free interval of 180 days or switching to another TNF antagonist, anakinra, rituximab or abatacept. Persistence was estimated and compared using survival analysis. RESULTS:The study cohort included 2,923 patients, 63% treated with etanercept. Median persistence in years (95% confidence interval) with infliximab was 3.7 (2.9-4.9), with adalimumab 3.3 (2.6-4.1) and with etanercept 3.8 (3.3-4.3). Similar risk of discontinuation was observed for the three drugs: the hazard ratio (95% confidence interval) was 0.98 (0.85-1.13) comparing infliximab with etanercept, 0.95 (0.78-1.15) comparing infliximab with adalimumab and 1.04 (0.88-1.22) comparing adalimumab with etanercept. CONCLUSIONS:Similar persistence was observed with infliximab, adalimumab and etanercept in rheumatoid arthritis patients during the first 9 years of use. If treatment persistence is a good proxy for the therapeutic benefit and harm of these drugs, then this finding suggests that the three drugs share an overall similar benefit-harm profile in rheumatoid arthritis patients. |
url |
http://europepmc.org/articles/PMC4139324?pdf=render |
work_keys_str_mv |
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