• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Sep 2005; 64(9): 1274–1279.
Published online Feb 11, 2005. doi:  10.1136/ard.2004.031476
PMCID: PMC1755655

Treatment continuation in patients receiving biological agents or conventional DMARD therapy

Abstract

Objective: To compare drug continuation rates in patients with rheumatoid arthritis who start on a biological agent and in a control group of patients with a change in disease modifying antirheumatic drug (DMARD) treatment after previous DMARD failure.

Methods: Patients with rheumatoid arthritis enrolled in the German biologics register between May 2001 and September 2003 were included in the study. Data were available for 511 patients treated with etanercept, 343 with infliximab, 70 with anakinra, and 599 controls. Propensity scores were used to select a subsample of patients from the control group who were likely to be treated with biological agents because of their disease severity, as well as comparable infliximab and etanercept cases.

Results: Treatment continuation after 12 months was similar for etanercept (68.6% (95% confidence interval, 62% to 75%)) and infliximab (65.4% (58% to 73%)) but lower for anakinra (59% (41% to 77%)). Treatment continuation was more likely for patients on combinations of biological agents and DMARDs than for those on infliximab or etanercept alone. Patients treated with biological agents were more severely ill than those in the control group and had more previous DMARD failures. After adjustment for baseline differences, the continuation rates were higher in patients treated with biological agents than in comparable control patients treated with leflunomide or leflunomide/methotrexate.

Conclusions: Treatment continuation of biological agents in clinical practice is less likely than in randomised clinical trials but more likely than in comparable controls treated with conventional DMARDs.

Full Text

The Full Text of this article is available as a PDF (86K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet. 1999 Dec 4;354(9194):1932–1939. [PubMed]
  • Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR, Smolen JS, Weisman M, Emery P, Feldmann M, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med. 2000 Nov 30;343(22):1594–1602. [PubMed]
  • Moreland LW, Schiff MH, Baumgartner SW, Tindall EA, Fleischmann RM, Bulpitt KJ, Weaver AL, Keystone EC, Furst DE, Mease PJ, et al. Etanercept therapy in rheumatoid arthritis. A randomized, controlled trial. Ann Intern Med. 1999 Mar 16;130(6):478–486. [PubMed]
  • Genovese Mark C, Bathon Joan M, Martin Richard W, Fleischmann Roy M, Tesser John R, Schiff Michael H, Keystone Edward C, Wasko Mary Chester, Moreland Larry W, Weaver Arthur L, et al. Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum. 2002 Jun;46(6):1443–1450. [PubMed]
  • Cohen Stanley, Hurd Eric, Cush John, Schiff Michael, Weinblatt Michael E, Moreland Larry W, Kremer Joel, Bear Moraye B, Rich William J, McCabe Dorothy. Treatment of rheumatoid arthritis with anakinra, a recombinant human interleukin-1 receptor antagonist, in combination with methotrexate: results of a twenty-four-week, multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2002 Mar;46(3):614–624. [PubMed]
  • Lautenschläger J, Mau W, Kohlmann T, Raspe HH, Struve F, Brückle W, Zeidler H. Vergleichende Evaluation einer deutschen Version des Health Assessment Questionnaires (HAQ) und des Funktionsfragebogens Hannover (FFbH). Z Rheumatol. 1997 May-Jun;56(3):144–155. [PubMed]
  • Hoekstra Monique, van de Laar Mart A F J, Bernelot Moens Hein J, Kruijsen Marijn W M, Haagsma Cees J. Longterm observational study of methotrexate use in a Dutch cohort of 1022 patients with rheumatoid arthritis. J Rheumatol. 2003 Nov;30(11):2325–2329. [PubMed]
  • Klareskog Lars, van der Heijde Désirée, de Jager Julien P, Gough Andrew, Kalden Joachim, Malaise Michel, Martín Mola Emilio, Pavelka Karel, Sany Jacques, Settas Lucas, et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet. 2004 Feb 28;363(9410):675–681. [PubMed]
  • Cohen Stanley, Hurd Eric, Cush John, Schiff Michael, Weinblatt Michael E, Moreland Larry W, Kremer Joel, Bear Moraye B, Rich William J, McCabe Dorothy. Treatment of rheumatoid arthritis with anakinra, a recombinant human interleukin-1 receptor antagonist, in combination with methotrexate: results of a twenty-four-week, multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2002 Mar;46(3):614–624. [PubMed]
  • Dougados Maxime, Emery Paul, Lemmel Ernst-Martin, de la Serna Rodriguez, Zerbini Cristiano A, Brin Sylvie, van Riel Piet. Efficacy and safety of leflunomide and predisposing factors for treatment response in patients with active rheumatoid arthritis: RELIEF 6-month data. J Rheumatol. 2003 Dec;30(12):2572–2579. [PubMed]
  • Kremer Joel M, Genovese Mark C, Cannon Grant W, Caldwell Jacques R, Cush John J, Furst Daniel E, Luggen Michael E, Keystone Ed, Weisman Michael H, Bensen William M, et al. Concomitant leflunomide therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2002 Nov 5;137(9):726–733. [PubMed]
  • Flendrie M, Creemers MCW, Welsing PMJ, den Broeder AA, van Riel PLCM. Survival during treatment with tumour necrosis factor blocking agents in rheumatoid arthritis. Ann Rheum Dis. 2003 Nov;62 (Suppl 2):ii30–ii33. [PMC free article] [PubMed]
  • van Vollenhoven Ronald F, Ernestam Sofia, Harju Anders, Bratt Johan, Klareskog Lars. Etanercept versus etanercept plus methotrexate: a registry-based study suggesting that the combination is clinically more efficacious. Arthritis Res Ther. 2003;5(6):R347–R351. [PMC free article] [PubMed]
  • Geborek P, Crnkic M, Petersson IF, Saxne T. Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden. Ann Rheum Dis. 2002 Sep;61(9):793–798. [PMC free article] [PubMed]

Figures and Tables

Figure 1
 Probability of treatment continuation in patients receiving biological agents.
Figure 2
 Probability of treatment continuation in patients with an increased likelihood of being treated with tumour necrosis factor (propensity score >50%).

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • Compound
    Compound
    PubChem Compound links
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles
  • Substance
    Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...