Drug retention of biological DMARD in rheumatoid arthritis patients: the role of baseline characteristics and disease evolution
Language English Country Great Britain, England Media print
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
31209481
DOI
10.1093/rheumatology/kez221
PII: 5519821
Knihovny.cz E-resources
- Keywords
- DMARDs, abatacept, biological therapies, epidemiology, rheumatoid arthritis, time-varying, tocilizumab, tumour necrosis alpha inhibitors,
- MeSH
- Abatacept therapeutic use MeSH
- Antirheumatic Agents therapeutic use MeSH
- Time Factors MeSH
- Antibodies, Monoclonal, Humanized therapeutic use MeSH
- Incidence MeSH
- Middle Aged MeSH
- Humans MeSH
- Withholding Treatment * MeSH
- Prospective Studies MeSH
- Registries * MeSH
- Arthritis, Rheumatoid diagnosis drug therapy epidemiology MeSH
- Decision Making * MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe epidemiology MeSH
- Names of Substances
- Abatacept MeSH
- Antirheumatic Agents MeSH
- Antibodies, Monoclonal, Humanized MeSH
- Tumor Necrosis Factor-alpha MeSH
- tocilizumab MeSH Browser
OBJECTIVE: To examine the association of the evolution in physician-reported and patient-reported outcomes with decision to stop biological DMARDs (bDMARDs) in RA. The contribution of baseline characteristics is well established, but little is known about how the disease evolution influences the decision to discontinue therapy. METHODS: RA patients who initiated a bDMARD treatment from 2009 and with information on date of visit were pooled from seven European RA registers. Each outcome was divided into baseline assessments (capturing the inter-individual differences at drug initiation) and changes from baseline at subsequent visits (capturing the individual evolution). Cox regression models were used to examine their association with drug discontinuation, adjusting for baseline patient and co-therapy characteristics and stratifying by register and calendar year of drug initiation. RESULTS: A total of 25 077 patients initiated a bDMARDs (18 507 a TNF-inhibitor, 3863 tocilizumab and 2707 abatacept) contributing an amount of 46 456.8 patient-years. Overall, drug discontinuation was most strongly associated with a poor evolution of the DAS28, with a hazard ratio of 1.34 (95% CI 1.29, 1.40), followed by its baseline value. A change of Physician Global Assessment was the next strongest predictor of discontinuation, then the Patient Global Assessment. CONCLUSIONS: The decision to discontinue treatments appears to be mostly influenced by DAS28 and particularly its evolution over time, followed by Physician Global Assessment evolution, suggesting that the decision to stop bDMARDs relies more on the physician's than on the patient's global assessment.
Center of Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania Italy
Department of Rheumatology Diakonhjemmet Hospital Oslo Norway
Division of Rheumatology University Hospitals Geneva Geneva Switzerland
GISEA University Hospital of Bari Bari Italy
Institute of Rheumatology Prague and Clinic of Rheumatology Charles University Prague Czech Republic
Rheumatology Department Hospital Garcia de Orta Almada Portugal on behalf of Reuma pt
Rheumatology Unit Clinical University Hospital University of Santiago de Compostela Santiago Spain
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