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

Journal of Rheumatology - Tập 43 Số 10 - Trang 1787-1794 - 2016
S. Manders1, Wietske Kievit2, Tim Jansen3, Jan Stolk4, Henk Visser5, A. Schilder6, Harald E. Vonkeman7, Eddy Adang8, Mart A F J van de Laar9, Piet L. C. M. van Riel10
1Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede,
2 Rheumatology, Ziekenhuis Gelderse Vallei, Ede
3 Rheumatology, Rijnstate, Arnhem
4 Rheumatology, Medical Centre Leeuwarden, Leeuwarden
5 Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, #N#the Netherlands.
6 W. Kievit, PhD, Department of Health Evidence, Radboud University Medical Center
7 T.L. Jansen, PhD, Department of Rheumatic Diseases, Radboud University Medical Center
8 J.N. Stolk, PhD, Rheumatology, Ziekenhuis Gelderse Vallei
9 H. Visser, PhD, Rheumatology, Rijnstate
10 A.M. Schilder, MD, Rheumatology, Medical Centre Leeuwarden

Tóm tắt

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.

Từ khóa


Tài liệu tham khảo

10.1016/S0140-6736(04)15640-7

10.1002/art.21655

10.1007/s10165-010-0324-4

10.1002/art.21519

10.1136/ard.2009.116319

10.1002/1529-0131(199809)41:9<1552::AID-ART5>3.0.CO;2-W

10.1136/ard.2009.126532

10.1136/ard.2007.072447

Yazici, 2008, Utilization of biologic agents in rheumatoid arthritis in the United States: analysis of prescribing patterns in 16,752 newly diagnosed patients and patients new to biologic therapy, Bull NYU Hosp Jt Dis, 66, 77

10.1007/s10067-013-2281-8

10.1002/art.21830

10.1136/ard.2010.139774

Detert, 2015, Biologic monotherapy in the treatment of rheumatoid arthritis, Biologics, 9, 35

10.1136/ard.2007.085696

Kalden, 2005, Use of combination of leflunomide with biological agents in treatment of rheumatoid arthritis, J Rheumatol, 32, 1620

DREAM registry . 2012. [Internet. Accessed June 16, 2016.] Available from: www.dreamregistry.nl

10.1002/art.1780310302

10.1002/art.1780380107

10.1002/art.1780230202

Seltman HJ . Mixed models: a flexible approach to correlated data. [Internet. Accessed June 16, 2016.] Available from: www.stat.cmu.edu/~hseltman/309/Book/chapter15.pdf

10.1186/ar2084

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Thông tin xuất bản

Journal of Rheumatology

Tập 43 Số 10

1787-1794

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