Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Direct Comparison of 4 Years Drug Survival of Adalimumab, Etanercept and Infliximab in Rheumatoid Arthritis Patients. An Observational Study From the DANBIO Registry

Hetland1,  M.L., Christensen2,  I.J., Tarp3,  U., Dreyer1,  L., Hansen1,  A., Hansen1,  I.T., Kollerup1,  G.

DANBIO, On behalf of Depts of Rheumatology, North, South, Central, Sealand and Capital Region. Copenhagen, Denmark
Copenhagen, Denmark
DANBIO, Copenhagen, Denmark

Purpose:

Data on the withdrawal rates of different TNF-inhibitors (TNF-I) in clinical practice are scarce. The aim was to determine 4-year drug survival of the different TNF-I and calculate Hazard Ratios (HRs) of their withdrawal based on the DANBIO registry.

Methods:

2935 RA patients (832 (28%) adalimumab, 703 (24%) etanercept, 1400 (48%) infliximab) were followed from start of first TNF-I treatment to withdrawal of treatment or Oct 1st 2008 (whichever came first). HRs were calculated correcting for baseline disease activity, age, disease duration, concomitant methotrexate and prednisolone, number of previous DMARDs, HAQ score and hospital department. Propensity scores and various subanalyses gave similar results, not shown.

Results:

Figure shows 4 years' (unadjusted) drug survival: adalimumab:56%(95%CI:51–61%); etanercept:63%(58–68%); infliximab:44%(41–47%), p<0.0001, log rank test.

Below the figure, numbers of events and numbers of patients at risk at different time points for each drug are shown.

HRs for drug withdrawal, incl. subanalyses by reason for withdrawal, are shown in table.

Table. Hazard Ratios (95% CI) for drug withdrawal

 Adalimumab vs. etanerceptInfliximab vs. etanerceptInfliximab vs. adalimumab
All pts (1099 events)1.56 (1.26–1.94)2.10 (1.70–2.591.35 (1.13–1.61)
LOE (727 events)1.51 (1.17–1.96)1.73 (1.35–2.23)1.15 (0.92–1.42)
AE (327 events)1.73 (1.14–2.62)3.19 (2.15–4.72)1.85 (1.35–2.52)
LOE: lack of efficacy; AE: adverse event

Conclusion:

In this nationwide follow-up study of 2935 RA patients, 4 years' drug survival was highest for etanercept. After correcting for differences in baseline characteristics, the hazard ratio for withdrawal was overall highest for infliximab and lowest for etanercept regardless of reason for withdrawal.

Conflict of Interest:

The DANBIO registry received unrestricted grants from Abbott, BMS, Roche, Schering-Plough, UCB Nordic and Wyeth.

To cite this abstract, please use the following information:
Hetland, M.L., Christensen, I.J., Tarp, U., Dreyer, L., Hansen, A., Hansen, I.T., et al; Direct Comparison of 4 Years Drug Survival of Adalimumab, Etanercept and Infliximab in Rheumatoid Arthritis Patients. An Observational Study From the DANBIO Registry [abstract]. Arthritis Rheum 2009;60 Suppl 10 :997
DOI: 10.1002/art.26074

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