Abstract
Objective
Tumor necrosis factor-α (TNF) inhibitors have transformed management of rheumatoid arthritis (RA); however, many patients discontinue TNF inhibitors. Our goal was to determine the discontinuation rate of TNF inhibitors and identify predictors associated with discontinuation.
Methods
Enrollees in the Brigham RA Sequential Study (BRASS) formed the eligible cohort. Patients reporting use of a TNF inhibitor with at least 6 months of followup were followed until reporting TNF inhibitor discontinuation or their last study visit if they continued therapy. Potential predictor variables, including demographic and clinical data assessed at baseline and 6 months prior to study endpoint, were identified using a Cox proportional regression.
Results
Among 961 patients in BRASS, 503 were using a TNF inhibitor with at least 6 months of followup in BRASS (mean length of followup 39 mo, SD 13). Two hundred ten patients (42%) reported discontinuation of TNF inhibitor. Higher physician global scores (hazard ratio 1.27, 95% CI 1.18–1.38) and RA Disease Activity Index scores (HR 1.13, 95% CI 1.05–1.22) 6 months prior to stopping the TNF inhibitor and higher number of TNF inhibitors used previously (HR 1.30, 95% CI 1.03–1.66) were associated with discontinuation of TNF inhibitor. Prior use of synthetic disease modifying antirheumatic drugs (HR 0.50, 95% CI 0.34–0.72) and more years of cumulative methotrexate use (HR 0.24, 95% CI 0.12–0.47) were inversely associated with discontinuation of TNF inhibitor.
Conclusion
These data demonstrate that a significant number of patients with RA discontinue TNF inhibitors. Several easily characterized clinical variables have a modest predictive association with reduced probability of TNF inhibitor discontinuation.
Key Indexing Terms:Footnotes
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S.K. Agarwal, MD, PhD, Division of Rheumatology, Immunology, Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, and Division of Rheumatology, Department of Internal Medicine, The University of Texas Health Science Center at Houston; R.J. Glass, MS; N.A. Shadick, MD; J.S. Coblyn, MD; R.J. Anderson, MD; N.E. Maher, MS; M.E. Weinblatt, MD; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology, Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School.
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Establishment of the Brigham RA Sequential Study cohort was supported by Millennium Inc. Dr. Agarwal is a past recipient of the Abbott Scholar Award in Rheumatology Research. Dr. Shadick is supported by grants from Millennium Inc., National Institutes of Health/NIAMS R01 AR49880, Centers for Disease Control, and the Bristol Myers Squibb Foundation [Patient Centered Outcomes (PACO) Initiative]. Dr. Weinblatt is supported by a grant from the Arthritis Foundation and its Engalitcheff Arthritis Outcomes Initiative, and the Bristol Myers Squibb Foundation (PACO Initiative). Dr. Solomon is supported by grants from the NIH (AR48616, AG027066), the Arthritis Foundation, and the Engalitcheff Arthritis Outcomes Initiative.
- Accepted for publication April 15, 2008.