Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis

data from Reuma.pt

Joao Lagoas Gomes, Alexandre Sepriano, Mónica Eusébio, Sofia Serra, João Eurico Fonseca, Maira João Saavedra, Luís Cunha-Miranda, Cândida Silva, Miguel Bernardes, Diana Rosa-Gonçalves, José Costa, Walter Castelão, Jaime Cunha Branco, Maria José Santos

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To assess the discontinuation of first-line biological treatment and to evaluate the reasons and predictors thereof in patients with rheumatoid arthritis (RA) from daily clinical practice. METHODS: RA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) starting treatment with biologic DMARDs (bDMARDs) were included in this prospective observational study. The main outcome was the time to discontinuation (in years) due to any cause. Discontinuation was defined as a 90-day discontinuation of treatment or the occurrence of any switch to another bDMARD during follow-up. Baseline and time-varying sociodemographic and clinical characteristics were tested as possible predictors of discontinuation using multivariable Cox models. RESULTS: Of the 1,851 RA patients included in the study, 871 (47%) discontinued their first bDMARD. The median overall persistence of the first bDMARD was 5.5 years and the leading cause of discontinuation was inefficacy [N=476 (55%)], followed by adverse events [N=262 (30%)], other causes [N=69, (8%)] and unknown causes [N=64 (7%)]. Patients with a higher HAQ score (more disability) at baseline were more likely to discontinue their first bDMARD [hazard ratio (HR):1.39 (95% CI: 1.17-1.64)], as were patients with a higher number of comorbidities [HR: 1.17 (1.05-1.29)] and patients starting treatment from 2007 onwards [HR:1.89 (1.5-2.38)]. On the contrary, receiving TNFi bDMARD [HR:0.74 (0.57-0.94)] as opposed to non-TNFi was associated with less discontinuation. Expectedly, the higher the DAS28 during follow-up the higher the likelihood to discontinue bDMARD [HR:1.08 (1.06-1.1)]. No other time-varying predictor was found. CONCLUSION: In the Portuguese RA population, maintenance of first-line bDMARD was shown to be relatively high. Inefficacy was the leading cause of discontinuation. Features found to predict drug discontinuation (e.g. baseline disability) may contribute to inform clinician's decisions in clinical practice.

Original languageEnglish
Pages (from-to)57-64
Number of pages8
JournalActa reumatologica portuguesa
Volume44
Issue number1
Publication statusPublished - Jan 2019

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Antirheumatic Agents
Biological Factors
Rheumatoid Arthritis
ametantrone
Therapeutics
Rheumatic Diseases
Proportional Hazards Models
Observational Studies
Comorbidity
Maintenance
Prospective Studies

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Gomes, Joao Lagoas ; Sepriano, Alexandre ; Eusébio, Mónica ; Serra, Sofia ; Fonseca, João Eurico ; Saavedra, Maira João ; Cunha-Miranda, Luís ; Silva, Cândida ; Bernardes, Miguel ; Rosa-Gonçalves, Diana ; Costa, José ; Castelão, Walter ; Branco, Jaime Cunha ; Santos, Maria José. / Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis : data from Reuma.pt. In: Acta reumatologica portuguesa. 2019 ; Vol. 44, No. 1. pp. 57-64.
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title = "Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis: data from Reuma.pt",
abstract = "OBJECTIVES: To assess the discontinuation of first-line biological treatment and to evaluate the reasons and predictors thereof in patients with rheumatoid arthritis (RA) from daily clinical practice. METHODS: RA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) starting treatment with biologic DMARDs (bDMARDs) were included in this prospective observational study. The main outcome was the time to discontinuation (in years) due to any cause. Discontinuation was defined as a 90-day discontinuation of treatment or the occurrence of any switch to another bDMARD during follow-up. Baseline and time-varying sociodemographic and clinical characteristics were tested as possible predictors of discontinuation using multivariable Cox models. RESULTS: Of the 1,851 RA patients included in the study, 871 (47{\%}) discontinued their first bDMARD. The median overall persistence of the first bDMARD was 5.5 years and the leading cause of discontinuation was inefficacy [N=476 (55{\%})], followed by adverse events [N=262 (30{\%})], other causes [N=69, (8{\%})] and unknown causes [N=64 (7{\%})]. Patients with a higher HAQ score (more disability) at baseline were more likely to discontinue their first bDMARD [hazard ratio (HR):1.39 (95{\%} CI: 1.17-1.64)], as were patients with a higher number of comorbidities [HR: 1.17 (1.05-1.29)] and patients starting treatment from 2007 onwards [HR:1.89 (1.5-2.38)]. On the contrary, receiving TNFi bDMARD [HR:0.74 (0.57-0.94)] as opposed to non-TNFi was associated with less discontinuation. Expectedly, the higher the DAS28 during follow-up the higher the likelihood to discontinue bDMARD [HR:1.08 (1.06-1.1)]. No other time-varying predictor was found. CONCLUSION: In the Portuguese RA population, maintenance of first-line bDMARD was shown to be relatively high. Inefficacy was the leading cause of discontinuation. Features found to predict drug discontinuation (e.g. baseline disability) may contribute to inform clinician's decisions in clinical practice.",
author = "Gomes, {Joao Lagoas} and Alexandre Sepriano and M{\'o}nica Eus{\'e}bio and Sofia Serra and Fonseca, {Jo{\~a}o Eurico} and Saavedra, {Maira Jo{\~a}o} and Lu{\'i}s Cunha-Miranda and C{\^a}ndida Silva and Miguel Bernardes and Diana Rosa-Gon{\cc}alves and Jos{\'e} Costa and Walter Castel{\~a}o and Branco, {Jaime Cunha} and Santos, {Maria Jos{\'e}}",
year = "2019",
month = "1",
language = "English",
volume = "44",
pages = "57--64",
journal = "Acta reumatologica portuguesa",
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Gomes, JL, Sepriano, A, Eusébio, M, Serra, S, Fonseca, JE, Saavedra, MJ, Cunha-Miranda, L, Silva, C, Bernardes, M, Rosa-Gonçalves, D, Costa, J, Castelão, W, Branco, JC & Santos, MJ 2019, 'Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis: data from Reuma.pt', Acta reumatologica portuguesa, vol. 44, no. 1, pp. 57-64.

Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis : data from Reuma.pt. / Gomes, Joao Lagoas; Sepriano, Alexandre; Eusébio, Mónica; Serra, Sofia; Fonseca, João Eurico; Saavedra, Maira João; Cunha-Miranda, Luís; Silva, Cândida; Bernardes, Miguel; Rosa-Gonçalves, Diana; Costa, José; Castelão, Walter; Branco, Jaime Cunha; Santos, Maria José.

In: Acta reumatologica portuguesa, Vol. 44, No. 1, 01.2019, p. 57-64.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis

T2 - data from Reuma.pt

AU - Gomes, Joao Lagoas

AU - Sepriano, Alexandre

AU - Eusébio, Mónica

AU - Serra, Sofia

AU - Fonseca, João Eurico

AU - Saavedra, Maira João

AU - Cunha-Miranda, Luís

AU - Silva, Cândida

AU - Bernardes, Miguel

AU - Rosa-Gonçalves, Diana

AU - Costa, José

AU - Castelão, Walter

AU - Branco, Jaime Cunha

AU - Santos, Maria José

PY - 2019/1

Y1 - 2019/1

N2 - OBJECTIVES: To assess the discontinuation of first-line biological treatment and to evaluate the reasons and predictors thereof in patients with rheumatoid arthritis (RA) from daily clinical practice. METHODS: RA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) starting treatment with biologic DMARDs (bDMARDs) were included in this prospective observational study. The main outcome was the time to discontinuation (in years) due to any cause. Discontinuation was defined as a 90-day discontinuation of treatment or the occurrence of any switch to another bDMARD during follow-up. Baseline and time-varying sociodemographic and clinical characteristics were tested as possible predictors of discontinuation using multivariable Cox models. RESULTS: Of the 1,851 RA patients included in the study, 871 (47%) discontinued their first bDMARD. The median overall persistence of the first bDMARD was 5.5 years and the leading cause of discontinuation was inefficacy [N=476 (55%)], followed by adverse events [N=262 (30%)], other causes [N=69, (8%)] and unknown causes [N=64 (7%)]. Patients with a higher HAQ score (more disability) at baseline were more likely to discontinue their first bDMARD [hazard ratio (HR):1.39 (95% CI: 1.17-1.64)], as were patients with a higher number of comorbidities [HR: 1.17 (1.05-1.29)] and patients starting treatment from 2007 onwards [HR:1.89 (1.5-2.38)]. On the contrary, receiving TNFi bDMARD [HR:0.74 (0.57-0.94)] as opposed to non-TNFi was associated with less discontinuation. Expectedly, the higher the DAS28 during follow-up the higher the likelihood to discontinue bDMARD [HR:1.08 (1.06-1.1)]. No other time-varying predictor was found. CONCLUSION: In the Portuguese RA population, maintenance of first-line bDMARD was shown to be relatively high. Inefficacy was the leading cause of discontinuation. Features found to predict drug discontinuation (e.g. baseline disability) may contribute to inform clinician's decisions in clinical practice.

AB - OBJECTIVES: To assess the discontinuation of first-line biological treatment and to evaluate the reasons and predictors thereof in patients with rheumatoid arthritis (RA) from daily clinical practice. METHODS: RA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) starting treatment with biologic DMARDs (bDMARDs) were included in this prospective observational study. The main outcome was the time to discontinuation (in years) due to any cause. Discontinuation was defined as a 90-day discontinuation of treatment or the occurrence of any switch to another bDMARD during follow-up. Baseline and time-varying sociodemographic and clinical characteristics were tested as possible predictors of discontinuation using multivariable Cox models. RESULTS: Of the 1,851 RA patients included in the study, 871 (47%) discontinued their first bDMARD. The median overall persistence of the first bDMARD was 5.5 years and the leading cause of discontinuation was inefficacy [N=476 (55%)], followed by adverse events [N=262 (30%)], other causes [N=69, (8%)] and unknown causes [N=64 (7%)]. Patients with a higher HAQ score (more disability) at baseline were more likely to discontinue their first bDMARD [hazard ratio (HR):1.39 (95% CI: 1.17-1.64)], as were patients with a higher number of comorbidities [HR: 1.17 (1.05-1.29)] and patients starting treatment from 2007 onwards [HR:1.89 (1.5-2.38)]. On the contrary, receiving TNFi bDMARD [HR:0.74 (0.57-0.94)] as opposed to non-TNFi was associated with less discontinuation. Expectedly, the higher the DAS28 during follow-up the higher the likelihood to discontinue bDMARD [HR:1.08 (1.06-1.1)]. No other time-varying predictor was found. CONCLUSION: In the Portuguese RA population, maintenance of first-line bDMARD was shown to be relatively high. Inefficacy was the leading cause of discontinuation. Features found to predict drug discontinuation (e.g. baseline disability) may contribute to inform clinician's decisions in clinical practice.

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JO - Acta reumatologica portuguesa

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