PT  - JOURNAL ARTICLE
AU  - Florenzo Iannone
AU  - Elisa Gremese
AU  - Fabiola Atzeni
AU  - Domenico Biasi
AU  - Costantino Botsios
AU  - Paola Cipriani
AU  - Clodoveo Ferri
AU  - Valentina Foschi
AU  - Mauro Galeazzi
AU  - Roberto Gerli
AU  - AnnaRita Giardina
AU  - Antonio Marchesoni
AU  - Fausto Salaffi
AU  - Tamara Ziglioli
AU  - Giovanni Lapadula
TI  - Longterm Retention of Tumor Necrosis Factor-α Inhibitor Therapy in a Large Italian Cohort of Patients with Rheumatoid Arthritis from the GISEA Registry: An Appraisal of Predictors
AID  - 10.3899/jrheum.111125
DP  - 2012 Apr 01
TA  - The Journal of Rheumatology
PG  - jrheum.111125
4099  - http://www.jrheum.org/content/early/2012/03/25/jrheum.111125.short
4100  - http://www.jrheum.org/content/early/2012/03/25/jrheum.111125.full
AB  - Objective To evaluate 4-year retention rates of tumor necrosis factor-α (TNF-α) inhibitors adalimumab, etanercept, and infliximab among patients with longstanding rheumatoid arthritis (RA), as derived from an Italian national registry. Methods The clinical records of 853 adult patients with RA in the GISEA (Gruppo Italiano Studio Early Arthritis) registry were prospectively analyzed to compare drug survival rates and the baseline factors that may predict adherence to therapy. Results In 2003 and 2004, 324 patients started treatment with adalimumab, 311 with etanercept, and 218 with infliximab. After 4 years, the global retention rate of anti-TNF-α therapy was 42%. Etanercept survival (51.4%) was significantly better than that of infliximab (37.6%) or adalimumab (36.4%; p < 0.0001). Accordingly, the mean duration of therapy was significantly longer for etanercept (3.1 ± 2 yrs) than for adalimumab (2.6 ± 2 yrs) or infliximab (2.7 ± 2 yrs; p < 0.05). The use of concomitant disease-modifying antirheumatic drugs, mainly methotrexate, and the presence of comorbidities significantly predicted drug continuation (p < 0.01), whereas a high Disease Activity Score did not. Conclusion The 4-year global drug survival of adalimumab, etanercept, and infliximab was lower than 50%, with etanercept having the best retention rate. The main positive predictor of adherence to anti-TNF-α therapy was the concomitant use of methotrexate. Our study provides further evidence that the real-life treatment of patients with RA may be different from that of randomized clinical trials.