Optimal Public Goods Provision: Implications of Endogenizing the Labor/Leisure Choice

Abstract

<h3>Background</h3> “Head to head” studies comparing the efficacy and tolerability of different TNF inhibitors are scarce, in particular the comparison between certolizumab pegol and golimumab. <h3>Objectives</h3> To compare the efficaciousness, drug survival and tolerability of certolizumab-pegol and golimumab in adult patients with establish arthritis (RA, JIA, SpA or unspecified polyarthritis) starting these treatments between February 2010 and December 2013 at out-patient unit at the Skåne University Hospital, Department of Rheumatology Lund/Malmö and two associated private rheumatology units. <h3>Methods</h3> All patients starting treatment with biologics were consecutively included in the South Swedish Arthritis Treatment Group (SSATG) register and regularly followed up according the standard protocol including: SJC/TJC, CRP, ESR, physicians global assessment of disease activity, patients9 assessment of disease activity and pain (VAS global and VAS pain) and HAQ. Last follow up date was October 17th 2016. Kaplan-Meier survival analysis was used to estimate the drug survival. Possible predictors of drug survival were analysed using Cox regression model. <h3>Results</h3> In total, 352 patients (71% women, mean age 51 years, mean disease duration 12 years, started these treatments during study period. Of these, 168 received golimumab and 184 certulizumab-pegol. Mean treatment time was 31 months (range 0–77). Percentage of patients with RA, SpA, JIA and unspecified arthritis were 58,4%, 16,4%, 5,7%, and 19,5% respectively. Certolizumab-pegol was more used in RA (67% vs 49%) and JIA (8% vs 2%) while golimumab was more frequent among patients with SpA (21% and 12%) or PsA (23% and 10, respectively). Only 7% of golimumab and 10% of certulizumab-pegol patients received these drugs as first biologic treatment and approximately 50% of patients received these drugs as ≥3. biological treatment. In golimumab treated patients mean DAS28 decreased from 4,3 (baseline) to 3,3 (3 months); 2,8 (6 months) and 2,7 (12 months) but levelled off at 36 months follow up. Corresponding mean DAS28 levels in certulizumab-pegol treated patients were 4,6 (baseline); 3,2 (3 months); 2,8 (6 months) and 2,6 (12 months). The similar pattern was seen in changes in HAQ and CDAI over the study time. There were no statistically significant differences in DAS, HAQ or CDAI between treatments at any follow up visit. At the end of follow up 64 (38%) of golimumab and 60 (32%) of certulizumab-pegol patients remained on their treatment. No significant difference in drug survival was seen between the treatments (Figure). Patients with spondylartropathy had significantly better survival on golimumab compared to RA patients (p=0,005)whicih remained after adjustment for age, gender, CRP, number of previous biologics and concomitnt methotrexate at baseline. <h3>Conclusions</h3> Spondylarthropathy including psoriatic arthritis was associated with better drug survival on golimunab compared to certolizumab pegol. No other significant differences in efficacy, tolerability or drug survival were seen between golimumab and certolizumab pegol in patients with established arthritis in daily clinical practice. Approximately one third of patients starting these treatments remained on treatment after 3 years. <h3>Disclosure of Interest</h3> None declared