Comparison of drug survival on adalimumab, etanercept, golimumab and infliximab in patients with axial spondyloarthritis

PLoS One. 2019 May 30;14(5):e0216746. doi: 10.1371/journal.pone.0216746. eCollection 2019.

Abstract

Objectives: To compare drug survival in patients with axial spondyloarthritis treated with different TNF inhibitors in standard dosage.

Methods: Patients fulfilling the Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis in the Swiss Clinical Quality Management cohort were included in this study if a first TNF inhibitor on standard dosage was started after recruitment and if a baseline visit was available. Drug maintenance up to drug discontinuation or dose escalation was compared between TNF inhibitors with multiple adjusted Cox proportional hazards models and multiple imputation for missing baseline covariate data.

Results: A total of 966 patients were included (adalimumab 344, etanercept 237, golimumab 214, infliximab 171). Patients on certolizumab (n = 18) were excluded. Patients starting golimumab had lower disease activity as well as better physical function and quality of life in comparison to patients starting another drug. A higher proportion of patients starting infliximab had a history of extra-articular manifestations. Drug dosage was more often escalated during follow-up in patients treated with infliximab than with subcutaneously administered agents. However, no significant differences in time up to drug discontinuation or dose escalation were observed in multiple adjusted analyses if treatment was initiated after 2009, when all 4 TNF inhibitors were available: hazard ratio for infliximab versus etanercept 1.16 (95% confidence interval 0.80; 1.67), p = 0.44, for golimumab versus etanercept 0.80 (0.58; 1.10), p = 0.17 and for adalimumab versus etanercept 0.93 (0.69; 1.26), p = 0.66.

Conclusion: In axial spondyloarthritis, drug survival with standard doses of different TNF inhibitors is comparable.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adalimumab / administration & dosage*
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Antibodies, Monoclonal / administration & dosage*
  • Antirheumatic Agents / administration & dosage
  • Etanercept / administration & dosage*
  • Female
  • Humans
  • Infliximab / administration & dosage*
  • Male
  • Middle Aged
  • Spondylarthritis / drug therapy*
  • Time Factors
  • Tumor Necrosis Factor Inhibitors / administration & dosage

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Tumor Necrosis Factor Inhibitors
  • golimumab
  • Infliximab
  • Adalimumab
  • Etanercept

Grants and funding

The SCQM Foundation is supported by the Swiss Society of Rheumatology and by AbbVie, Celgene, iQone, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, UCB. It has also been supported by Bristol-Myers-Squibb and Janssen-Cilag and has received project-based financial supports from the Arco Foundation, Switzerland, as well as from the Swiss Balgrist Society, Switzerland. This study was supported by Pfizer through an investigator-initiated research grant to SCQM. The grant provider had no role in the study design or in the collection, analysis, or interpretation of the data, the writing of the manuscript, or the decision to submit the manuscript for publication. Publication of this article was not contingent upon approval by the grant donor.