Half of RA Patients Stop Long-Term Anti-TNF Treatment; Decreased Effectiveness is Main Reason

Half of RA Patients Stop Long-Term Anti-TNF Treatment; Decreased Effectiveness is Main Reason

Rheumatoid arthritis (RA) patients discontinue long treatments with anti-TNF therapies mainly because the drug therapies lose effectiveness, according to a new study.

The results, which included data from 123 patients with RA, were reported in a study titled “Reasons for Discontinuation and Adverse Effects of TNFα Inhibitors in a Cohort of Patients With Rheumatoid Arthritis and Ankylosing Spondylitis,” were published in the journal Annals of Pharmacotherapy.

RA patients often are initially treated with non-steroidal anti-inflammatory drugs and corticosteroids. When they stop to respond to the higher recommended doses of these medications, they initiate biological therapy with anti–tumor necrosis factor α agents (anti-TNFα), such as Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab), Simponi (golimumab), and Cimzia (certolizumab).

However, long-term use of anti-TNFα inhibitors may cause adverse effects and lead to treatment discontinuation, according to the study.

“Despite the favorable response of anti-TNFα drugs in the control of these diseases, most patients require long-term treatment. In this sense, these drugs may cause adverse effects that motivate a change in dosage regimen or even discontinuation of the treatment,” the authors wrote.

Researchers compared the effectiveness of the different TNFα inhibitor treatments in patients with RA and ankylosing spondylitis (AS), a form of spinal arthritis, treated at least for one year between 2008 and 2013.

The anti-TNF drug most commonly used was Humira (41.6%), followed by Enbrel (33.1%), and Remicade (22.2%). Simponi was used by just 3.1% of the RA patients.

Researchers found that 68 RA patients (55.3%) had stopped the anti-TNFα treatment — 60.9% of patients who were taking Remicade, 57.4% of those using Humira, and 32.1% of the patients medicated with Enbrel. One of the two patients taking Simponi Aria (50%) also stopped the treatment.

The most common cause of TNFα inhibitor discontinuation was the lack of efficacy (51.5%), followed by patient decision (29.4%). In 19.1% of the patients, there were reports of adverse effects, such as reactions after infusion or associated with the injection, cutaneous reactions, severe headache and nerve hearing loss.

When researchers compared the different treatments for drug survival — time from initiation to discontinuation — they found it was greater for Enbrel than for Humira.

The authors believe that despite the small number of patients recruited to this study, it provides important information about the therapeutic use of anti-TNF drugs.

“In our study, the main cause of discontinuation of anti-TNFα treatment was therapeutic failure in both diseases, and the most frequent adverse effects were reactions associated with the infusion or the injection. Moreover, it was observed that etanercept [Enbrel] and infliximab [Remicade] were the drugs with the best drug survival rates in RA and AS, respectively.” the team concluded. “Our results point to the need for more extensive studies comparing the safety of anti-TNFα drugs, so that they will be useful in making treatment decisions in these patients.”

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