Abstract
This study aimed to investigate drug retention rates for various TNF inhibitors (TNFis) commonly prescribed to Korean patients with ankylosing spondylitis (AS) in the Korean College of Rheumatology Biologics registry (KOBIO; December 2012–June 2016). Discontinuation was defined as switching or stopping the biologic agent. Kaplan–Meier curves and Cox's proportional hazard models were used for further analysis. The reasons for discontinuation of TNFis were also assessed. Univariate and multivariate analyses were used to identify possible predictors of discontinuation. Data from 1,005 patients with AS were analyzed with a median follow-up period of 14 months. Seventy-six percent of patients were first-line biologic users. Discontinuation of TNFis occurred in 24.2% (switching in 9.6%) of patients during follow-up. An estimate of the drug failure showed that the adjusted hazard ratio (HR) for golimumab compared to etanercept was 0.441 (95% confidence interval: 0.277–0.703, p < 0.001). Reasons for discontinuation included lack of efficacy (32.6%), adverse events (23.6%), clinical improvement (11.2%), and others (32.6%). Predictors of discontinuation using a multivariate analysis were a shorter disease duration (HR: 0.973, p = 0.044) and being negative for HLA-B27 (HR: 1.623, p = 0.0093). In conclusion, few Korean patients with AS switched to other TNFis during their treatment. The drug retention rate for golimumab was higher than for other agents.
Highlights
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that predominantly affects the sacroiliac joint and spine and is characterized by chronic back pain and stiffness [1]
An estimate of the drug failure showed that the adjusted hazard ratio (HR) for golimumab compared to etanercept was 0.441
body mass index (BMI), This study demonstrated that discontinuation of TNF inhibitors (TNFis) occurred in 24.2% of patients with ankylosing spondylitis (AS) during a median 14-month follow-up period
Summary
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that predominantly affects the sacroiliac joint and spine and is characterized by chronic back pain and stiffness [1]. The data showed that all TNFis provide rapid and sustained improvement in disease symptoms and improve function in patients with AS [3,4,5] Several factors, such as a young age, a high baseline level of inflammatory markers, and short disease duration, have been reported to be predictors of a good response to TNFis [6]. These data are limited in terms of allowing for a direct comparison of the efficacy, safety, and drug survival rate among several TNFis in real-life [7]
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