Discontinuation rates of biologics in patients with rheumatoid arthritis

Are TNF inhibitors different from non-TNF inhibitors?

Sofia Ramiro, Robert Landewé, Désirée Van Der Heijde, David Harrison, David Collier, Kaleb D Michaud

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To compare discontinuation rates of first and second biologics in rheumatoid arthritis (RA) by tumour-necrosis factor inhibitor (TNFi) status and identify predictors and reasons for discontinuation. Methods: From 1998 to 2011, self-reported medication use for RA was assessed every 6 months via questionnaire in a longitudinal study in the USA. Time-on-drug analyses were conducted for individual biologics and groups, and annual rates reported. Time to discontinuation of TNFi and non-TNFi was compared, unadjusted and adjusted using propensity score analyses. Baseline and time-varying predictors of biologic discontinuation were derived through Cox regression. Results: Of 2281 patients initiating their first biologic, 1100 (48%) discontinued and of 1097 initiating a second biologic, 537 (49%) discontinued. The annual discontinuation rate was 17% (median 4 years) for first biologic and 20% (median 3.3 years) for second biologic. TNFi had lower discontinuation rates than non-TNFi after propensity score adjustment: HR for first biologic 0.49 (0.34 to 0.71) and 0.68 (0.51 to 0.90) for second biologic. The annual discontinuation rate was significantly lower in patients starting their first biologic before January 2005 vs after (16 vs 25%, p=0.005). Predictors of discontinuation for the first biologic included smoking, higher comorbidity index, worse overall health and not using concomitant methotrexate. Conclusions: In this large cohort, patients with RA tended to remain on their first and second biologics for relatively long periods suggesting the drugs' effectiveness. Discontinuation rates were lower in patients using TNFi, and all rates increased after January 2005 when the number of biologics available increased.

Original languageEnglish (US)
Article numbere000155
JournalRMD Open
Volume1
Issue number1
DOIs
StatePublished - Jan 1 2015

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Biological Products
Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Propensity Score
Necrosis
Social Adjustment
Methotrexate
Pharmaceutical Preparations
Longitudinal Studies
Comorbidity
Smoking
Health

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Discontinuation rates of biologics in patients with rheumatoid arthritis : Are TNF inhibitors different from non-TNF inhibitors? / Ramiro, Sofia; Landewé, Robert; Van Der Heijde, Désirée; Harrison, David; Collier, David; Michaud, Kaleb D.

In: RMD Open, Vol. 1, No. 1, e000155, 01.01.2015.

Research output: Contribution to journalArticle

Ramiro, Sofia ; Landewé, Robert ; Van Der Heijde, Désirée ; Harrison, David ; Collier, David ; Michaud, Kaleb D. / Discontinuation rates of biologics in patients with rheumatoid arthritis : Are TNF inhibitors different from non-TNF inhibitors?. In: RMD Open. 2015 ; Vol. 1, No. 1.
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title = "Discontinuation rates of biologics in patients with rheumatoid arthritis: Are TNF inhibitors different from non-TNF inhibitors?",
abstract = "Objective: To compare discontinuation rates of first and second biologics in rheumatoid arthritis (RA) by tumour-necrosis factor inhibitor (TNFi) status and identify predictors and reasons for discontinuation. Methods: From 1998 to 2011, self-reported medication use for RA was assessed every 6 months via questionnaire in a longitudinal study in the USA. Time-on-drug analyses were conducted for individual biologics and groups, and annual rates reported. Time to discontinuation of TNFi and non-TNFi was compared, unadjusted and adjusted using propensity score analyses. Baseline and time-varying predictors of biologic discontinuation were derived through Cox regression. Results: Of 2281 patients initiating their first biologic, 1100 (48{\%}) discontinued and of 1097 initiating a second biologic, 537 (49{\%}) discontinued. The annual discontinuation rate was 17{\%} (median 4 years) for first biologic and 20{\%} (median 3.3 years) for second biologic. TNFi had lower discontinuation rates than non-TNFi after propensity score adjustment: HR for first biologic 0.49 (0.34 to 0.71) and 0.68 (0.51 to 0.90) for second biologic. The annual discontinuation rate was significantly lower in patients starting their first biologic before January 2005 vs after (16 vs 25{\%}, p=0.005). Predictors of discontinuation for the first biologic included smoking, higher comorbidity index, worse overall health and not using concomitant methotrexate. Conclusions: In this large cohort, patients with RA tended to remain on their first and second biologics for relatively long periods suggesting the drugs' effectiveness. Discontinuation rates were lower in patients using TNFi, and all rates increased after January 2005 when the number of biologics available increased.",
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AU - Collier, David

AU - Michaud, Kaleb D

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N2 - Objective: To compare discontinuation rates of first and second biologics in rheumatoid arthritis (RA) by tumour-necrosis factor inhibitor (TNFi) status and identify predictors and reasons for discontinuation. Methods: From 1998 to 2011, self-reported medication use for RA was assessed every 6 months via questionnaire in a longitudinal study in the USA. Time-on-drug analyses were conducted for individual biologics and groups, and annual rates reported. Time to discontinuation of TNFi and non-TNFi was compared, unadjusted and adjusted using propensity score analyses. Baseline and time-varying predictors of biologic discontinuation were derived through Cox regression. Results: Of 2281 patients initiating their first biologic, 1100 (48%) discontinued and of 1097 initiating a second biologic, 537 (49%) discontinued. The annual discontinuation rate was 17% (median 4 years) for first biologic and 20% (median 3.3 years) for second biologic. TNFi had lower discontinuation rates than non-TNFi after propensity score adjustment: HR for first biologic 0.49 (0.34 to 0.71) and 0.68 (0.51 to 0.90) for second biologic. The annual discontinuation rate was significantly lower in patients starting their first biologic before January 2005 vs after (16 vs 25%, p=0.005). Predictors of discontinuation for the first biologic included smoking, higher comorbidity index, worse overall health and not using concomitant methotrexate. Conclusions: In this large cohort, patients with RA tended to remain on their first and second biologics for relatively long periods suggesting the drugs' effectiveness. Discontinuation rates were lower in patients using TNFi, and all rates increased after January 2005 when the number of biologics available increased.

AB - Objective: To compare discontinuation rates of first and second biologics in rheumatoid arthritis (RA) by tumour-necrosis factor inhibitor (TNFi) status and identify predictors and reasons for discontinuation. Methods: From 1998 to 2011, self-reported medication use for RA was assessed every 6 months via questionnaire in a longitudinal study in the USA. Time-on-drug analyses were conducted for individual biologics and groups, and annual rates reported. Time to discontinuation of TNFi and non-TNFi was compared, unadjusted and adjusted using propensity score analyses. Baseline and time-varying predictors of biologic discontinuation were derived through Cox regression. Results: Of 2281 patients initiating their first biologic, 1100 (48%) discontinued and of 1097 initiating a second biologic, 537 (49%) discontinued. The annual discontinuation rate was 17% (median 4 years) for first biologic and 20% (median 3.3 years) for second biologic. TNFi had lower discontinuation rates than non-TNFi after propensity score adjustment: HR for first biologic 0.49 (0.34 to 0.71) and 0.68 (0.51 to 0.90) for second biologic. The annual discontinuation rate was significantly lower in patients starting their first biologic before January 2005 vs after (16 vs 25%, p=0.005). Predictors of discontinuation for the first biologic included smoking, higher comorbidity index, worse overall health and not using concomitant methotrexate. Conclusions: In this large cohort, patients with RA tended to remain on their first and second biologics for relatively long periods suggesting the drugs' effectiveness. Discontinuation rates were lower in patients using TNFi, and all rates increased after January 2005 when the number of biologics available increased.

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