THU0173 Retention Rates of Adalimumab, Etanercept and Infliximab as First and Second-Line Biologic Therapy in Patients with Rheumatoid Arthritis in Daily Practice: The Maintain Study
Authors: A. Frazier-Mironer, A. Cantagrel, B. Combe, V. Deschamps, M. Dougados, R.-M. Flipo, I. Logeart, X. Mariette, T. Schaeverbeke, J. Sibilia, X. Le Loët
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Efficacy and safety of TNFα inhibitors (TNFi) in rheumatoid arthritis (RA) have been evaluated in randomized controlled trials. The analysis of observational studies and registries provides additional real-world information. Drug survival rate reflects the real world balance between efficacy and safety. <h3>Objectives</h3> The primary objective of this study was to compare the retention rates (RR) of adalimumab (ADA), etanercept (ETN) and infliximab (IFX) as 1st-line biologic therapy in RA. The secondary objectives were to determine causes of discontinuation, factors associated with a better retention, and RR of 2d-line TNFi. <h3>Methods</h3> This is a retrolective, multicentre study in 8 French Rheumatology centres. The medical charts of all pts with RA who started TNFi therapy between March 1<sup>st</sup> 2005 and April 30<sup>th</sup> 2009 were reviewed, based on diagnosis and treatment (TT) codes, with a follow-up duration of min. 2 to max. 6 yrs. The RR was estimated using the Kaplan-Meier method. TNFi were compared after adjusting the inverse of a propensity score, using a Cox model. Factors associated with a better RR were identified by multivariate analysis. <h3>Results</h3> 706 pts were included in the study. The first TNFi was ADA in 203 (28.8%), ETN in 404 pts(57.2%) and IFX in 99 pts (14%). The percentage of pts still on TT after 2 yrs was 54.9%, 61.9% and 48.7% for ADA, ETN and IFX respectively. The median duration of trt was 31 mths for ADA (95% CI [19-38]), 45 mths for ETN (95% CI [35-51]) and 23 mths for IFX (95% CI [16-36]). The Hazard ratios (HRs) for discontinuing the first TNFi were significantly greater with ADA and IFX than with ETN (1.315, 95% CI [1.050-1.648] and 1.380, 95% CI [1.041-1.828] respectively). There was no significant difference between the 2 monoclonal antibodies. The HR for TT discontinuation due to lack of efficacy was significantly higher with ADA than ETN (1.511, 95% CI [1.152-1.982]). The HR for stopping trt due to adverse events was significantly higher with IFX than ETN (2.175 (95% CI [1.402-3.374]). Baseline characteristics associated with a better retention of the first TNFi were a higher number of previous DMARDs and a higher ESR. A second TNFi was administered to 231 pts: ADA in 105, ETN in 106, and IFX in 20 pts. The median retention period was 11 mths for ADA (95% CI [7-17]), 43 mths for ETN (95% CI [19.1-58]), and 19.1 mths for IFX (95% CI [5-NE]). The HR for discontinuing ADA was significantly greater than for ETN (2.023, 95% CI [1.393-2.937]). The HRs for stopping due to lack of efficacy or adverse events (AE) were significantly greater for ADA than for ETN (1.998, 95% CI [1.321-3.024] and 2.188, 95% CI [1.017-4.708] respectively). <h3>Conclusions</h3> ETN had a better RR as a first-line biotherapy in RA, with a HR for discontinuing ADA or IFX that was about 30% greater than that of ETN. As first-line biologic therapy, ETN had fewer withdrawals for inefficacy than ADA, and fewer withdrawals for AE than IFX. As a 2d-line TNFi, ETN also had a better RR than ADA. <h3>Disclosure of Interest</h3> A. Frazier-Mironer Consultant for: Pfizer, A. Cantagrel Grant/research support from: Chugai, Pfizer, UCB, Consultant for: Laboratoires BMS, Chugai, MSD France, Novartis, Pfizer, Roche, UCB, Speakers bureau: Laboratoires Abbott, BMS, Chugai, MSD France, Nordic-Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, B. Combe Grant/research support from: Pfizer, Roche, Chugai, Consultant for: BMS, Celgene, Merck, Novartis, Pfizer, Roche, Chugai, UCB, Speakers bureau: Merck, Pfizer, UCB, V. Deschamps Employee of: PFIZER, M. Dougados Grant/research support from: Pfizer, Abbott, Roche, BMS, Merck, Lilly, Novartis, Consultant for: Pfizer, Abbott, Roche, BMS, Merck, Lilly, Novartis, R.-M. Flipo Grant/research support from: Pfizer, Roche, Chugaï, Consultant for: Abbott, Astra-Zeneca, BMS, Ipsen-Ménarini, MSD, Pfizer, Roche, Chugaï, UCB, Janssen-Cilag, Paid instructor for: Abbott, Astra-Zeneca, BMS, Expansciences, Ipsen-Ménarini, MSD, Nordic-Pharma, Pfizer, Roche, Chugaï, Genzyme, UCB, I. Logeart Employee of: Pfizer, X. Mariette Consultant for: BMS, Pfizer, Roche et UCB, T. Schaeverbeke Consultant for: Roche, Chugai, Pfizer, J. Sibilia Grant/research support from: Roche, Pfizer, Merck Sharp, Bristol Myers Squibb, Speakers bureau: Roche, Chugai, Bristol Myers Squibb, Abbott, UCB, GSK, LFB, Actelion, Pfizer, Merck Sharp, Novartis, X. Le Loët Consultant for: MSD, Pfizer, Roche