Factors affecting discontinuation of adalimumab and etanercept therapy in anti-TNF-naïve patients with ankylosing spondylitis: Nationwide population-based cohort study

Hsin Hua Chen, Yi Ming Chen, Kuo Lung Lai, Ching Heng Lin, Chao Hsiung Tang, Der Yuan Chen

Research output: Contribution to journalArticle

Abstract

Objectives. We investigated factors associated with discontinuation of anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS), who were anti-TNF-naïve and were given etanercept (ETN) or adalimumab (ADA). Methods. This is a retrospective nationwide population-based cohort study. We identified 1401 anti-TNF-naïve patients with AS who initiated ETN (n = 441) or ADA (n = 960) and measured the duration of anti-TNF drug use. We recorded demographic and clinical data of all patients, and calculated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard regression analyses. Results. Overall, the ADA and ETN groups had similar risk for drug discontinuation (HR: 0.83; 95% CI: 0.63-1.08). In each group, concomitant use of methotrexate (MTX) or a non-steroidal anti-inflammatory drug was associated with a lower risk of discontinuation. Subgroup analysis indicated that concomitant MTX use reduced risk of discontinuation of ADA (HR: 0.54; 95% CI: 0.40-0.74), but not ETN (HR: 1.03; 95% CI: 0.65-1.63). Conclusions. This study of anti-TNF-naïve patients with AS indicated that users of ADA and ETN had similar overall risk of drug discontinuation. However, patients taking ADA with MTX had a lower risk of discontinuation than those taking ADA alone.

Original languageEnglish
Pages (from-to)903-907
Number of pages5
JournalModern Rheumatology
Volume25
Issue number6
DOIs
Publication statusPublished - Sep 8 2015

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Ankylosing Spondylitis
Cohort Studies
Tumor Necrosis Factor-alpha
Population
Methotrexate
Confidence Intervals
Pharmaceutical Preparations
Therapeutics
Etanercept
Adalimumab
Anti-Inflammatory Agents
Regression Analysis
Demography

Keywords

  • Adalimumab
  • Ankylosing spondylitis
  • Etanercept
  • Methotrexate
  • Treatment discontinuation
  • Tumor necrosis factor-α

ASJC Scopus subject areas

  • Rheumatology

Cite this

Factors affecting discontinuation of adalimumab and etanercept therapy in anti-TNF-naïve patients with ankylosing spondylitis : Nationwide population-based cohort study. / Chen, Hsin Hua; Chen, Yi Ming; Lai, Kuo Lung; Lin, Ching Heng; Tang, Chao Hsiung; Chen, Der Yuan.

In: Modern Rheumatology, Vol. 25, No. 6, 08.09.2015, p. 903-907.

Research output: Contribution to journalArticle

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abstract = "Objectives. We investigated factors associated with discontinuation of anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS), who were anti-TNF-na{\"i}ve and were given etanercept (ETN) or adalimumab (ADA). Methods. This is a retrospective nationwide population-based cohort study. We identified 1401 anti-TNF-na{\"i}ve patients with AS who initiated ETN (n = 441) or ADA (n = 960) and measured the duration of anti-TNF drug use. We recorded demographic and clinical data of all patients, and calculated adjusted hazard ratios (HRs) and 95{\%} confidence intervals (CIs) using Cox proportional hazard regression analyses. Results. Overall, the ADA and ETN groups had similar risk for drug discontinuation (HR: 0.83; 95{\%} CI: 0.63-1.08). In each group, concomitant use of methotrexate (MTX) or a non-steroidal anti-inflammatory drug was associated with a lower risk of discontinuation. Subgroup analysis indicated that concomitant MTX use reduced risk of discontinuation of ADA (HR: 0.54; 95{\%} CI: 0.40-0.74), but not ETN (HR: 1.03; 95{\%} CI: 0.65-1.63). Conclusions. This study of anti-TNF-na{\"i}ve patients with AS indicated that users of ADA and ETN had similar overall risk of drug discontinuation. However, patients taking ADA with MTX had a lower risk of discontinuation than those taking ADA alone.",
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T1 - Factors affecting discontinuation of adalimumab and etanercept therapy in anti-TNF-naïve patients with ankylosing spondylitis

T2 - Nationwide population-based cohort study

AU - Chen, Hsin Hua

AU - Chen, Yi Ming

AU - Lai, Kuo Lung

AU - Lin, Ching Heng

AU - Tang, Chao Hsiung

AU - Chen, Der Yuan

PY - 2015/9/8

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N2 - Objectives. We investigated factors associated with discontinuation of anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS), who were anti-TNF-naïve and were given etanercept (ETN) or adalimumab (ADA). Methods. This is a retrospective nationwide population-based cohort study. We identified 1401 anti-TNF-naïve patients with AS who initiated ETN (n = 441) or ADA (n = 960) and measured the duration of anti-TNF drug use. We recorded demographic and clinical data of all patients, and calculated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard regression analyses. Results. Overall, the ADA and ETN groups had similar risk for drug discontinuation (HR: 0.83; 95% CI: 0.63-1.08). In each group, concomitant use of methotrexate (MTX) or a non-steroidal anti-inflammatory drug was associated with a lower risk of discontinuation. Subgroup analysis indicated that concomitant MTX use reduced risk of discontinuation of ADA (HR: 0.54; 95% CI: 0.40-0.74), but not ETN (HR: 1.03; 95% CI: 0.65-1.63). Conclusions. This study of anti-TNF-naïve patients with AS indicated that users of ADA and ETN had similar overall risk of drug discontinuation. However, patients taking ADA with MTX had a lower risk of discontinuation than those taking ADA alone.

AB - Objectives. We investigated factors associated with discontinuation of anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS), who were anti-TNF-naïve and were given etanercept (ETN) or adalimumab (ADA). Methods. This is a retrospective nationwide population-based cohort study. We identified 1401 anti-TNF-naïve patients with AS who initiated ETN (n = 441) or ADA (n = 960) and measured the duration of anti-TNF drug use. We recorded demographic and clinical data of all patients, and calculated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard regression analyses. Results. Overall, the ADA and ETN groups had similar risk for drug discontinuation (HR: 0.83; 95% CI: 0.63-1.08). In each group, concomitant use of methotrexate (MTX) or a non-steroidal anti-inflammatory drug was associated with a lower risk of discontinuation. Subgroup analysis indicated that concomitant MTX use reduced risk of discontinuation of ADA (HR: 0.54; 95% CI: 0.40-0.74), but not ETN (HR: 1.03; 95% CI: 0.65-1.63). Conclusions. This study of anti-TNF-naïve patients with AS indicated that users of ADA and ETN had similar overall risk of drug discontinuation. However, patients taking ADA with MTX had a lower risk of discontinuation than those taking ADA alone.

KW - Adalimumab

KW - Ankylosing spondylitis

KW - Etanercept

KW - Methotrexate

KW - Treatment discontinuation

KW - Tumor necrosis factor-α

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