Background The effectiveness and safety of drugs for the treatment of inflammatory rheumatic diseases (IRD) are well known. Patients treated with disease modifying antirheumatic drugs (DMARDs) and anti-tumour necrosis factor alpha (TNF-alpha) drugs discontinue treatment for ineffectiveness and/or adverse reactions. The consequences are using different treatment lines to find the most effective and safe therapy.1
Purpose To analyse and compare the causes of switching of DMARDs and anti-TNF-alpha drugs in the treatment of IRD.
Material and methods Retrospective observational study (June 2008 to May 2013). All patients who met the following criteria were included: patients older than 18 years, with IRD and at least 3 months of anti-TNF therapy. The study variables were: diagnosis, previous DMARDs, causes of discontinuation/switching DMARDs, anti-TNF-alpha, concomitant anti-TNF-alpha drugs and causes of discontinuation/switching anti-TNF-alpha. The variables were obtained from the medical records and records of the dispensation of patients. The results are expressed as frequency measurements (%).
Results 498 patients were included. The main diagnoses were: 46.6% rheumatoid arthritis, 29.9% ankylosing spondylitis and 23.5% psoriatic arthritis. 416 patients (83.5%) were prescribed DMARDs prior to treatment with anti-TNF-alpha: 14.6% monotherapy and 88.4% combination therapy. 33.4% of patients discontinued treatment with DMARDs to start anti-TNF-alpha therapy. The causes of switching treatment with DMARDs were: 58.9% ineffectiveness, 38.9% adverse reactions and 2.2% other. The profile of prescribing anti-TNF-alpha was: 38.4% etanercept, 35.2% adalimumab, 15.6% infliximab, 7.9% golimumab and 2.9% certolizumab. 12.8% of patients without concomitant treatment with anti-TNF-alpha and 87.2% had concomitant treatment with anti-TNF-alpha. In 23.3% of patients with anti-TNF-alpha, switching occurred. The causes of switching from anti-TNF-alpha drugs were: 67.6% ineffectiveness, 29.9% adverse reactions and 2.5% other.
Conclusion Ineffectiveness was the major cause for switching treatment in inflammatory rheumatic diseases. Adverse reactions were the most common cause of switching DMARDs, but ineffectiveness of treatment was more common for anti-TNF-alpha drugs.
References and/or Acknowledgements
Bonafede M, et al. Treatment patterns in the first year after initiating tumor necrosis factor blockers in real-world settings. Adv Ther 2012;29:664-74
References and/or AcknowledgementsNo conflict of interest.
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