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

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.

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Comparative Persistence of Methotrexate and Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.190299 ◽

2019 ◽

Vol 47 (6) ◽

pp. 826-834

Author(s):

Michael D. George ◽

Joshua F. Baker ◽

Alexis Ogdie

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Tumor Necrosis Factor ◽

Tumor Necrosis ◽

Proportional Hazards ◽

Tumor Necrosis Factor Inhibitor ◽

Cox Proportional Hazards ◽

Medication Discontinuation ◽

Necrosis Factor

Objective.The role of methotrexate (MTX) for the treatment of spondyloarthritis (SpA) remains uncertain. Aims were to compare MTX and tumor necrosis factor inhibitor (TNFi) persistence in spondyloarthritis versus rheumatoid arthritis (RA) and to determine whether concomitant conventional synthetic disease-modifying antirheumatic drug (csDMARD) use is associated with improved TNFi persistence in SpA.Methods.This retrospective cohort study using Optum’s deidentified Clinformatics Data Mart Database 2000–2014 identified patients with RA, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) without prior biologic use who were initiating MTX or a TNFi. Cox proportional hazards models compared time to medication discontinuation over the next 2 years between patients with RA, PsA, or AS, adjusting for potential confounders. In similar analyses stratified by disease, Cox models were used to assess whether concomitant use of csDMARD was associated with TNFi persistence.Results.We identified 31,527 MTX initiators (26,708 RA, 2939 PsA, 1880 AS) and 34,651 TNFi initiators (24,134 RA, 6705 PsA, 3812 AS). MTX was discontinued sooner in patients with PsA [adjusted HR (aHR) 1.10, 95% CI 1.04–1.16] and AS (aHR 1.23, 1.16–1.31) versus RA, while TNFi were discontinued at similar rates in RA and AS and discontinued later in PsA (aHR 0.93, 0.89–0.97). Concomitant use of MTX (compared to no csDMARD) was associated with lower rates of TNFi discontinuation in RA (aHR 0.85, 0.80–0.89), PsA (aHR 0.81, 0.74–0.89), and AS (aHR 0.79, 0.67–0.93).Conclusion.MTX discontinuation occurs sooner in patients with PsA and AS versus RA. Concomitant use of MTX with a TNFi, however, is associated with improved TNFi persistence in all 3 diseases.

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

The Journal of Rheumatology ◽

10.3899/jrheum.131502 ◽

2015 ◽

Vol 42 (5) ◽

pp. 741-748 ◽

Cited By ~ 7

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.

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

The Journal of Rheumatology ◽

10.3899/jrheum.091447 ◽

2010 ◽

Vol 37 (12) ◽

pp. 2469-2474 ◽

Cited By ~ 12

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.

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Effect of Psychological Distress on Continuation of Anti-Tumor Necrosis Factor Therapy in Patients with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.100050 ◽

2010 ◽

Vol 37 (10) ◽

pp. 2021-2024 ◽

Cited By ~ 19

Author(s):

DEREK L. MATTEY ◽

PETER T. DAWES ◽

ANDREW B. HASSELL ◽

ANN BROWNFIELD ◽

JONATHAN C. PACKHAM

Keyword(s):

Rheumatoid Arthritis ◽

Psychological Distress ◽

Tumor Necrosis Factor ◽

Tumor Necrosis ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Smoking History ◽

Heavy Smoking ◽

Tnf Antagonists ◽

Necrosis Factor

Objective.To investigate the relationship of psychological distress and associated factors with continuation of tumor necrosis factor (TNF) antagonist therapy in patients with rheumatoid arthritis (RA).Methods.Patients about to start therapy with TNF antagonists (n = 166) were assessed for psychological distress using the Hospital Anxiety and Depression Scale (HADS). A core set of demographic and clinical variables, including comorbidities from medical records and cigarette smoking history by questionnaire, were recorded at baseline and regular intervals thereafter. Cox proportional hazards regression analysis was used to assess the likelihood of patients discontinuing therapy over a 36-month followup period.Results.The number of years smoked was associated with anxiety (HADS-A; p for trend = 0.008) and general psychological distress (HADS-Total; p for trend = 0.03). In univariate analyses, earlier discontinuation was associated with these variables at baseline: anxiety (HADS-A), depression (HADS-D), abnormal mood (HADS-Total), smoking history (> 30 pack-yrs), years smoked (> 30 yrs), current smoking, high Disease Activity Score 28-joint count (DAS28), poor patient global assessment, and evidence of cardio/cerebrovascular disease (CVD). In multivariate analyses, the strongest predictors of discontinuation were HADS-Total, smoking history (> 30 pack-yrs), DAS28, and evidence of CVD at baseline.Conclusion.Discontinuation of therapy with TNF antagonists is independently associated with psychological distress, heavy smoking, and CVD at baseline.

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Golimumab in adolescents with Crohn’s disease refractory to previous tumor necrosis factor antibody

10.21203/rs.2.21120/v1 ◽

2020 ◽

Author(s):

Judith Pichler ◽

Nima Memaran ◽

Wolf-Dietrich Huber ◽

Christoph Aufricht ◽

Bettina Bidmon-Fliegenschnee

Keyword(s):

Crohn’S Disease ◽

Tumor Necrosis Factor ◽

Crohn's Disease ◽

Tumor Necrosis ◽

Activity Index ◽

Rescue Therapy ◽

Disease Activity Index ◽

Full Blood Count ◽

Faecal Calprotectin ◽

Necrosis Factor

Abstract Background Inducing and maintaining clinical remission in children with Crohn’s disease (CD) is associated with treatment with antibody to tumor necrosis factor (TNF)-α such as infliximab or adalimumab. In the treatment of paediatric CD, there are no data about the use of a third introduced subcutaneous TNF-antibody, golimumab, Methods We evaluated the efficacy of golimumab for adolescents with moderate/severe CD. Retrospective analyses were done in all 7 (5 girls) adolescents who received golimumab at a median age of 17 years for a median of 7.2 months. Paediatric Crohn’s disease activity index (PCDAI), full blood count, inflammatory markers, use of corticosteroids and adverse events were recorded. Results With golimumab, 5 of the 7 children were PCDAI responders and 2 entered remission (PCDAI<10). There was a significant increase in haematocrit after 2 weeks, faecal calprotectin was significantly reduced after 4 weeks compared to baseline. Out of five children, steroid withdrawal was possible in one and steroid reduction in two cases. There were no serious side effects. Conclusion With moderate/severe CD, golimumab induced and maintained clinical response. The majority of children were PCDAI responders, in most steroid sparing was possible. Golimumab might be an effective rescue therapy in refractory CD.

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Outcomes and Safety of Tumor Necrosis Factor Inhibitors in Reactive Arthritis: A Nationwide Experience from Iceland

The Journal of Rheumatology ◽

10.3899/jrheum.191307 ◽

2020 ◽

Vol 47 (10) ◽

pp. 1575-1581 ◽

Cited By ~ 1

Author(s):

Bjarni Thorsteinsson ◽

Arni J. Geirsson ◽

Niels S. Krogh ◽

Bjorn Gudbjornsson

Keyword(s):

Tumor Necrosis Factor ◽

Disease Activity ◽

Reactive Arthritis ◽

Tumor Necrosis ◽

Hospital Admissions ◽

Activity Index ◽

Disease Activity Index ◽

Tumor Necrosis Factor Inhibitors ◽

Antiinflammatory Drugs ◽

Necrosis Factor

Objective.Reactive arthritis (ReA) is a spondyloarthritis triggered by a bacterial infection. In cases where nonsteroidal antiinflammatory drugs and conventional synthetic disease-modifying antirheumatic drugs have failed, biologics such as tumor necrosis factor inhibitors (TNFi) have been used. However, limited evidence exists of the efficacy and safety of these drugs in ReA. We report on Icelandic patients with ReA who have been treated with TNFi, their characteristics, outcomes, and safety.Methods.We conducted an observational cohort study using the Icelandic nationwide database of biologic therapy (ICEBIO) supplemented with a retrospective study of electronic health record (EHR) data. Drug efficacy was assessed using disease activity scores and standardized questionnaires within ICEBIO; safety was assessed using ICEBIO and EHR data.Results.Thirty-eight patients with ReA were registered in the database. Eight were given TNFi within 1 year of symptom onset. At 6 and 18 months, there was a significant reduction in C-reactive protein (CRP), tender and swollen joints, visual analog scale for pain and fatigue, 28-joint count Disease Activity Score 28 based on CRP, Clinical Disease Activity Index, and Health Assessment Questionnaire scores. Seventy-one to 90% of patients were considered treatment responders. Two patients were able to stop biologics owing to remission. During the 303 patient-years (mean 8, range 1–15) biologics were given, 6 hospital admissions for infections were noted.Conclusion.TNFi are safe and effective in ReA, but treatment tends to be prolonged. Further clinical trials are urgently needed in ReA.

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Disease Activity Cutoff Values in Initiating Tumor Necrosis Factor Inhibitor Therapy in Ankylosing Spondylitis: A German GO-NICE Study Subanalysis

The Journal of Rheumatology ◽

10.3899/jrheum.181040 ◽

2019 ◽

Vol 47 (1) ◽

pp. 35-41 ◽

Cited By ~ 2

Author(s):

Jürgen Braun ◽

Xenofon Baraliakos ◽

Uta Kiltz ◽

Klaus Krüger ◽

Gerd R. Burmester ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Tumor Necrosis Factor ◽

Disease Activity ◽

Tumor Necrosis ◽

Activity Index ◽

Tumor Necrosis Factor Inhibitor ◽

Disease Activity Index ◽

Factor Inhibitor ◽

Group 2 ◽

Necrosis Factor

Objective.International recommendations for the management of axial spondyloarthritis including ankylosing spondylitis (AS) recommend a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) level of disease activity of ≥ 4 to initiate treatment with biologics. We aimed to evaluate the level of disease activity used to initiate tumor necrosis factor inhibitor (TNFi) treatment and the level of responses to treatment based on different BASDAI cutoffs.Methods.This is a posthoc analysis of the noninterventional, prospective, GO-NICE study in the subgroup of biologic-naive AS treated with golimumab (GOL) 50 mg subcutaneously once monthly.Results.Of the 244 biologic-naive AS patients at baseline, 70.5% had a BASDAI ≥ 4 (Group 1), 14.3% had 2.8 to < 4 (Group 2), and 15.2% had even < 2.8 (Group 3). A total of 134 patients (54.9%) completed the 24-month observational period. The mean BASDAI in Groups 1, 2, and 3 was initially 5.9 ± 1.3, 3.4 ± 0.4, and 2.0 ± 0.8, decreased to 2.2 ± 2.0, 1.9 ± 1.2, and 1.0 ± 1.2 within 3 months (all p < 0.0001 vs baseline), and decreased significantly to 2.2 ± 1.7, 1.9 ± 1.7, and 1.4 ± 1.0 at Month 24 (all p < 0.005), respectively. BASDAI 50% improvement was noted in 68.8%, 44.8%, and 45.2% of patients at Month 3, and in 84.9%, 61.9%, and 55.0% at Month 24.Conclusion.TNFi treatment was initiated in almost a third of AS patients with lower disease activity states as assessed by BASDAI cutoff of ≥ 4. Patients with a BASDAI between 2.8 and < 4 appeared to benefit significantly from GOL treatment, while patients with BASDAI < 2.8 did not. This finding should lead to a reevaluation of the established BASDAI cutoff of ≥ 4.

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The Reason for Discontinuation of the First Tumor Necrosis Factor (TNF) Blocking Agent Does Not Influence the Effect of a Second TNF Blocking Agent in Patients with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.090054 ◽

2009 ◽

Vol 36 (10) ◽

pp. 2171-2177 ◽

Cited By ~ 33

Author(s):

MARLIES BLOM ◽

WIETSKE KIEVIT ◽

JAAP FRANSEN ◽

INA H. KUPER ◽

ALFONS A. den BROEDER ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Adverse Events ◽

Tumor Necrosis ◽

Response Rates ◽

Blocking Agent ◽

Das28 Score ◽

Loss Of Response ◽

Secondary Outcomes ◽

Necrosis Factor

Objective.To investigate whether the reason for discontinuation of the first tumor necrosis factor (TNF) blocking agent influences the effect of a second TNF blocking agent.Methods.Data were used from 2 Dutch registries including patients with rheumatoid arthritis (RA) treated with TNF blocking agents. Patients were divided into 3 groups based on reason for discontinuation of the first: nonresponse, loss of response, or adverse events. The primary outcome was the change from baseline of the disease activity (by DAS28) at 6 months, corrected for the baseline DAS28 score. Secondary outcomes were the change from baseline at 3 months, EULAR response rates, and the percentages of patients who reached a DAS28 score ≤ 3.2 at 3 and at 6 months.Results.In total, 49 patients who failed due to nonresponse, 75 due to loss of response, and 73 due to adverse events were included. At 6 months, the change of DAS28 score from baseline did not differ significantly between the groups (−0.6 to −1.3; p ≥ 0.173) and similar good and moderate response rates were found (12% to 18%, p ≥ 0.523, and 34% to 55%, p ≥ 0.078, respectively). The secondary outcomes were also comparable between the 3 groups.Conclusion.The results of our observational study suggest that a second TNF blocking agent may be effective after failure of the first, regardless of the reason for discontinuation of the first TNF blocking agent.

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Ameliorative Potential of Minocycline and/or Lactulose on Experimentally Induced Colitis

International Journal of Pharmacology Phytochemistry and Ethnomedicine ◽

10.18052/www.scipress.com/ijppe.2.42 ◽

2016 ◽

Vol 2 ◽

pp. 42-54

Author(s):

Ahmed M. Kabel

Keyword(s):

Nitric Oxide ◽

Tumor Necrosis Factor ◽

Tumor Necrosis Factor Alpha ◽

Tumor Necrosis ◽

Reduced Glutathione ◽

Activity Index ◽

Disease Activity Index ◽

Necrosis Factor Alpha ◽

Factor Alpha ◽

Necrosis Factor

The aim of this study was to compare between the effect of minocycline or lactulose alone and in combination on experimentally-induced colitis in rats.Materials and methods:Seventy albino rats were divided into 7 equal groups: Control untreated group, trinitrobenzenesulphonic acid (TNBS) group, TNBS + lactulose group, lactulose group, TNBS + minocycline group, minocycline group and TNBS + lactulose+ minocycline group. A part of the colon was homogenized for determination of tissue tumor necrosis factor alpha, malondialdehyde, nitric oxide, reduced glutathione and myeloperoxidase. The other part of the colon was examined histopathologically. Also, disease activity index was measured.Results:Administration of each of lactulose or minocycline alone and in combination to TNBS-treated rats induced significant increase in tissue reduced glutathione with significant decrease in disease activity index, tissue tumor necrosis factor alpha, malondialdehyde, nitric oxide and myeloperoxidase and alleviated the histopathological changes compared to the group that received TNBS alone. Minocycline/lactulose combination produced significant improvement in the biochemical and histopathological parameters compared to the groups that received either minocycline or lactulose alone.Conclusion:Lactulose and minocycline had protective effects on TNBS-induced colitis in rats but minocycline/lactulose combination had the upper hand.

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VP176 Effectiveness Of Anti-Tumor Necrosis Factor In Patients With Psoriatic Arthritis

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317004111 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 232-232

Author(s):

Michael da Silva ◽

Jéssica dos Santos ◽

Alessandra Almeida ◽

Juliana Alvares ◽

Augusto Guerra ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Tumor Necrosis Factor ◽

Disease Activity ◽

Latin American ◽

Tumor Necrosis ◽

Activity Index ◽

Disease Activity Index ◽

The Mean ◽

Necrosis Factor

INTRODUCTION:Anti-tumor necrosis factor drugs (anti-TNF) are the last line of treatment for psoriatic arthritis (PsA) in the guideline of Brazilian Public Health System (SUS). Data of effectiveness of these drugs are scarce in the Latin American population. This study evaluated the effectiveness of the anti-TNF on a cohort of patients with PA in the SUS.METHODS:PsA patients treated with anti-TNF, were included in an open prospective cohort study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI) were used to assess the effectiveness at six months of follow-up. The anti-TNF was considered effective when the patient achieves scores of four or less measured for BASDAI or scores of ten or less for CDAI. Frequency distributions were compiled for the sociodemographic variables and mean and standard deviation (SD) was used for clinical variables. The paired Student t-test was established to evaluate the differences between baseline and 6 months evaluated for BASDAI and CDAI.RESULTS:Fifty-four patients with PsA completed six months of follow-up. The mean age of patients was 54.03 years (10.44) and the mean disease duration was 8.00 years (7.49). Furthermore, 50 percent of the patients were female, 61.1 percent white and 59.6 percent married. The most used anti-TNF was adalimumab (63.0 percent), followed by etanercept (20.4 percent) and infliximab (16.7 percent). The anti-TNF reduced disease activity measured by BASDAI and CDAI at six months of follow-up (p<.001). The percentage of patients achieving the effectiveness with anti-TNF was 61.1 percent measured by BASDAI and 53.7 percent by CDAI.CONCLUSIONS:Anti-TNF drugs demonstrated to be effective in more than half of patients at six months. This result highlighted the importance of the treatment with the anti-TNF drugs in the Brazilian population. Long-term data are needed to confirm these results.

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