Comparative effectiveness of TNF inhibitors and tocilizumab with and without conventional synthetic disease-modifying antirheumatic drugs in a pan-European observational cohort of bio-naive patients with rheumatoid arthritis

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Lauper , K , Mongin , D , Iannone , F , Kristianslund , E K , Kvien , T K , Nordström , D C , Pavelka , K , Pombo-Suarez , M , Rotar , Z , Santos , M J , Codreanu , C , Lukina , G , Gale , S L , John , M , Luder , Y , Courvoisier , D S & Gabay , C 2020 , ' Comparative effectiveness of TNF inhibitors and tocilizumab with and without conventional synthetic disease-modifying antirheumatic drugs in a pan-European observational cohort of bio-naive patients with rheumatoid arthritis ' , Seminars in Arthritis and Rheumatism , vol. 50 , no. 1 , pp. 17-24 . https://doi.org/10.1016/j.semarthrit.2019.06.020

Title: Comparative effectiveness of TNF inhibitors and tocilizumab with and without conventional synthetic disease-modifying antirheumatic drugs in a pan-European observational cohort of bio-naive patients with rheumatoid arthritis
Author: Lauper, Kim; Mongin, Denis; Iannone, Florenzo; Kristianslund, Eirik K.; Kvien, Tore K.; Nordström, Dan C.; Pavelka, Karel; Pombo-Suarez, Manuel; Rotar, Ziga; Santos, Maria J.; Codreanu, Catalin; Lukina, Galina; Gale, Sara L.; John, Markus; Luder, Yves; Courvoisier, Delphine S.; Gabay, Cem
Contributor: University of Helsinki, HUS Internal Medicine and Rehabilitation
Date: 2020-02
Language: eng
Number of pages: 8
Belongs to series: Seminars in Arthritis and Rheumatism
ISSN: 0049-0172
URI: http://hdl.handle.net/10138/312687
Abstract: Objectives To compare treatment effectiveness in rheumatoid arthritis (RA) patients naïve to biological disease-modifying antirheumatic drugs (bDMARDs) treated with tocilizumab (TCZ) or TNF-inhibitor (TNFi) with (-combo) or without (-mono) conventional synthetic DMARDs (csDMARDs). Methods Patients with RA across 7 European registries, naïve to bDMARDs who initiated treatment with TCZ or TNFi from 2009 to 2016 were included. Drug retention rate was analyzed using Kaplan–Meier and Cox models, and CDAI over time by mixed models. The proportions of patients reaching CDAI low disease activity (LDA) and remission after one year were corrected for attrition. Results 6713 TNFi-combo, 3762 TNFi-mono, 646 TCZ-combo and 384 TCZ-mono were eligible. Crude median retention was 3.67 years (95%CI 3.41-3.83) for TNFi-combo, 4.14 (3.77-4.62) for TNFi-mono, 2.98 (2.76-3.34) for TCZ-combo and 3.63 years (3.34-5.03) for TCZ-mono. After adjustment for covariates, country and year of treatment initiation stratification, hazards of discontinuation were lower for TCZ-mono (0.60, 95% CI 0.52-0.69) and TCZ-combo (0.66, 95% CI 0.54-0.81) compared to TNFi-combo. Adjusted CDAI evolution was not significantly different between groups. CDAI LDA and remission corrected for attrition were similar between TCZ with or without csDMARDs and TNFi-combo. Conclusion In routine care across 7 European countries, the adjusted drug retention, adjusted CDAI over time and attrition-corrected response proportion for RA patients were similar for bio-naïve patients if treated with TNFi-combo, TCZ-combo or TCZ-mono.
Subject: 3121 General medicine, internal medicine and other clinical medicine
Rheumatoid arthritis
Biological therapies
DMARDs
Tocilizumab
TNF inhibitors
Epidemiology
Monotherapy
SURVIVAL
MANAGEMENT
VALIDATION
DISCONTINUATION
THERAPY
DOUBLE-BLIND
REMISSION
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