Canadian Variation by Province in Rheumatoid Arthritis Initiating Anti–Tumor Necrosis Factor Therapy: Results from the Optimization of Adalimumab Trial

2010 ◽  
Vol 37 (12) ◽  
pp. 2469-2474 ◽  
Author(s):  
CHRISTOPHER PEASE ◽  
JANET E. POPE ◽  
CARTER THORNE ◽  
BOULOS PAUL HARAOUI ◽  
DON TRUONG ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Health Assessment ◽  
Provincial Government ◽  
Joint Disease ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Canadian Provinces ◽  
Necrosis Factor

Objective.We compared variations among Canadian provinces in rheumatoid arthritis (RA) initiating anti-tumor necrosis factor (TNF) therapy.Methods.Data were obtained from the Optimization of Humira trial (OH) and from the Ontario Biologics Research Initiative (OBRI). Baseline characteristics were compared between regions: Ontario (ON), Quebec (QC), and other provinces (OTH). We compared Ontario OH to OBRI patients who were initiating anti-TNF therapy.Results.In 300 OH patients, mean age was 54.8 years (13.3). There were 151 (50.3%) ON patients, 57 from QC (19%), and 92 from OTH (30.7%). Regional differences were seen in the number of disease-modifying antirheumatic drugs (DMARD) ever taken (ON: 3.8 ± 1.4, QC: 3.1 ± 1.1, OTH: 3.3 ± 1.4; p < 0.001); swollen joint count (SJC; ON: 10.9 ± 5.9, QC: 9.0 ± 4.4, OTH: 11.3 ± 5.6; p = 0.033); tender joint count (TJC; ON: 12.2 ± 7.5, QC: 10.3 ± 5.7, OTH: 14.4 ± 7.6; p = 0.003); 28-joint Disease Activity Score (DAS28; ON: 5.8 ± 1.2, QC: 5.6 ± 1.0, OTH: 6.0 ± 1.1; p = 0.076); and Health Assessment Questionnaire (ON: 1.4 ± 0.7, QC: 1.7 ± 0.7, OTH: 1.5 ± 0.7; p = 0.060). DMARD-ever use differed: methotrexate (ON: 94.7%, QC: 93%, OTH: 84.8%; p = 0.025); leflunomide (ON: 74.8%, QC: 21.1%, OTH: 51.1%; p < 0.001); sulfasalazine (ON: 51%, QC: 38.6%, OTH: 25%; p < 0.001); myochrysine (ON: 9.3%, QC: 0%, OTH: 15.2%; p = 0.008); and hydroxychloroquine (ON: 67.5%, QC: 86%, OTH: 66.3%; p = 0.018). In comparison to ON OH patients, 95 OBRI patients initiating first anti-TNF had lower SJC (p = 0.017), TJC (p = 0.008), and DAS28 (p = 0.05).Conclusion.In Quebec, where access to anti-TNF is less restrictive, patients had lower SJC and TJC. ON used more DMARD, especially leflunomide, as mandated by the provincial government. Both provincial funding criteria and prescribing habits may contribute to differences. Canadian rheumatologists may vary in treatment decisions, but patients generally have similar DAS28 when initiating anti-TNF therapy.

scholarly journals Sustained Remission in Tumor Necrosis Factor Inhibitor–treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study

2015 ◽  
Vol 42 (5) ◽  
pp. 741-748 ◽  
Author(s):  
Jon Thorkell Einarsson ◽  
Pierre Geborek ◽  
Tore Saxne ◽  
Meliha C. Kapetanovic
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Health Assessment ◽  
Tumor Necrosis Factor Inhibitor ◽  
Population Based ◽  
Joint Disease ◽  
Sustained Remission ◽  
Reference Drug ◽  
Necrosis Factor

Objective.To study frequency, possible baseline predictors, timing, and duration of sustained remission [SR; defined as 28-joint Disease Activity Score (DAS28) < 2.6 for at least 6 mos] in patients with established rheumatoid arthritis (RA) treated with different tumor necrosis factor (TNF) inhibitors [etanercept (ETN), infliximab (IFX), adalimumab (ADA)]. In addition, the aim was to compare (head-to-head) the effectiveness of individual drugs in patients receiving their first anti-TNF treatment.Methods.All anti-TNF–treated patients with RA included in the observational South Swedish Arthritis Group register were eligible. We identified the patients’ first SR periods (time between first visit after treatment initiation with DAS28 < 2.6 and subsequent visit with DAS28 ≥ 2.6). Baseline predictors of SR in biologic-naive patients were studied using multivariate regression models. Remission duration and timing of remission start was estimated with Kaplan-Meier curves.Results.Of the 2416 patients included, 382 (15.8%) fulfilled the criteria for SR. Median estimated duration of SR was 5.25 years. Predictors for SR were male sex, low Health Assessment Questionnaire, low DAS28, methotrexate (MTX) treatment, and the calendar year of treatment start. OR for achieving SR within the first 12 months of treatment were 1.86 for ETN (95% CI 1.33–2.61) compared to IFX. HR for 4 years of SR were 1.32 for ETN (95% CI 1.01–1.74) and 1.84 for ADA (95% CI 1.23–2.78), with IFX as the reference drug.Conclusion.SR was uncommon in patients with RA treated with anti-TNF in clinical practice. However, patients remained in SR for a substantial period of time. Concomitant MTX treatment predicts remission. ETN and ADA were more likely in reaching SR.

Effectiveness of Tumor Necrosis Factor Inhibitors in Combination with Various csDMARD in the Treatment of Rheumatoid Arthritis: Data from the DREAM Registry

2016 ◽  
Vol 43 (10) ◽  
pp. 1787-1794 ◽  
Author(s):  
Sofie H.M. Manders ◽  
Wietske Kievit ◽  
Tim L.T.A. Jansen ◽  
Jan N. Stolk ◽  
Henk Visser ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Cox Regression ◽  
Tumor Necrosis Factor Inhibitor ◽  
Added Value ◽  
Joint Disease ◽  
Drug Survival ◽  
Necrosis Factor ◽  
Over Time

Objective.To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire–Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice.Methods.Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders.Results.The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value.Conclusion.Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.

Persistence with Anti-Tumor Necrosis Factor Therapies in Patients with Rheumatoid Arthritis: Observations from the RADIUS Registry

2011 ◽  
Vol 38 (7) ◽  
pp. 1273-1281 ◽  
Author(s):  
JOSEPH A. MARKENSON ◽  
ALLAN GIBOFSKY ◽  
WILLIAM R. PALMER ◽  
EDWARD C. KEYSTONE ◽  
MICHAEL H. SCHIFF ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Adverse Events ◽  
Tumor Necrosis ◽  
Proportional Hazards ◽  
Activity Index ◽  
Health Assessment ◽  
Disease Activity Index ◽  
Cox Proportional Hazards ◽  
Necrosis Factor

Objective.To evaluate persistence with anti-tumor necrosis factor (TNF) therapy and predictors of discontinuation in patients with rheumatoid arthritis (RA).Methods.This retrospective analysis used data from RADIUS 1, a 5-year observational registry of patients with RA, to determine time to first- and second-course discontinuation of etanercept, infliximab, and adalimumab. First-course therapy was defined as first exposure to anti-TNF therapy, and second-course therapy was defined as exposure to anti-TNF therapy after the first discontinuation. Kaplan-Meier survival analysis was used to assess persistence, log-rank tests were used to compare therapies, and Cox proportional hazards models were used to assess potential predictors of treatment discontinuation.Results.This analysis included 2418 patients. Mean persistence rates were similar among treatments [first-course: etanercept, 51%; infliximab, 48%; adalimumab, 48% (followup was 54 weeks for etanercept and infliximab and 42 weeks for adalimumab); second-course: 56%, 50%, 46%, respectively (followup was 36 weeks for etanercept and infliximab and 30 weeks for adalimumab)]. Discontinuations of first-course therapy due to ineffectiveness were similar among treatments (etanercept, 19%; infliximab, 19%; adalimumab, 20%) and discontinuations due to adverse events were significantly (p = 0.0006) lower for etanercept than for infliximab (etanercept, 14%; infliximab, 22%; adalimumab, 17%). Predictors from univariable analysis of first- or second-course therapy discontinuation included increased comorbidities (etanercept), female sex (infliximab), Clinical Disease Activity Index > 22 (infliximab), and a Stanford Health Assessment Questionnaire score > 0.5 (adalimumab).Conclusion.In this population, first- and second-course persistence was similar among anti-TNF therapies. First-course discontinuation due to adverse events was lower with etanercept compared with infliximab.

Circulating E-selectin and tumor necrosis factor-α in extraarticular involvement and joint disease activity in rheumatoid arthritis

2008 ◽  
Vol 29 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Esther G. Corona-Sanchez ◽  
Laura Gonzalez-Lopez ◽  
Jose F. Muñoz-Valle ◽  
Monica Vazquez-Del Mercado ◽  
Maria A. Lopez-Olivo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Disease Activity ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Joint Disease ◽  
Factor Α ◽  
Necrosis Factor ◽  
Extraarticular Involvement

scholarly journals An estimate of functional state in patients with rheumatoid arthritis

2009 ◽  
Vol 62 (5-6) ◽  
pp. 273-277 ◽  
Author(s):  
Snezana Tomasevic-Todorovic ◽  
Slobodan Brankovic ◽  
Ksenija Boskovic
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Functional Disability ◽  
Disease Duration ◽  
Health Assessment ◽  
Functional Class ◽  
Joint Disease ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Radiological Damage

Introduction Rheumatoid arthritis is an inflammatory chronic disease that affects 0.5-1% of the population, many of whom develop disease as working-age adults. Material and methods The aim of examination was to estimate functional disability in patients with rheumatoid arthritis and relationship between radiological damage, disease duration, disease activity, functional disability. The examination involved 60 patients with rheumatoid arthritis, aged (53.92?7.06) of both genders (48 female, 12 male). The following varables were assessed at one time point: swollen and tender joint count, visual analogue scale for pain, erythrocite sedimentation rate, health assessment questionnaire (HAQ) score, anatomical stage and functional class according to Stenbrocker's criteria. Disease activity was expressed as 28 joint disease activity score (DAS28). Correlations were calculated by Spearman's coefficient of correlation. Results In our study 82% of the patients had II and III anatomical stage and 80% of the patients had II and III functional class according to Steinbrocker's criteria. The median HAQ score was 1.25 ?0.70, and the median DAS28 was 5.74?0.98. Poor functional status was observed in 37 (61.66%) of the patients with an HAQ score of = 2. Functional disability in patients with rheumatoid arthritis was most strongly related to the presence of pain (rs=0.338, p<0.01) and to a lesser extent to anatomical and functional stage, disease duration, disease activity. Discussion and Conclusion The results of the study show that functional disability significantly correlated with subjective pain score (rs=0.338, p<0.01). We observed strong correlation between functional disability presented by HAQ score and pain but no significant correlation with other common clinical variables used for rheumatoid arthritis patients evaluation such as disease duration, disease activity, radiological damage.

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