AB0225 TUMOR NECROSIS FACTOR ALPHA (TNF-Α) INHIBITORS IN PATIENTS WITH REFRACTORY RHEUMATOID ARTHRITIS: REASONS FOR WITHDRAWAL
Authors: V. Sygyrta, E. Aronova, A. Lila, S. Glukhova
Journal: Annals of the Rheumatic Diseases (2021)

Background: Refractory rheumatoid arthritis (RRA) is a subtype of rheumatoid arthritis (RA), in which the sequential administration of optimal methotrexate doses in combination with glucocorticoids, and at least - two biologic disease-modifying antirheumatic drugs (bDMARDs) with different mechanisms of action during 18-24 months does not lead to a significant decrease in the inflammatory activity of RA. Objectives: to determine the reasons for the withdrawal of TNF-α inhibitors in patients with RRA. Methods: The retrospective study included data of 95 RRA patients (80 females, 80.8%), aged 23 to 80 years (mean age 57 years), treated with TNF-α inhibitors. Mean RA duration was 11.9±7.6 years. All patients were divided into 6 groups depending on the number of the lines of therapy received. A total of 154 cases of TNF-α were studied. Results: Infliximab (INF ) was most often prescribed as the first line of therapy - 40 prescriptions. The reasons for the withdrawal of INF as the first bDMARDs were: insufficient effectiveness (IE) - 20 cases (50% of appointments), administrative reasons (AdmR) - 13 cases (32.5% of appointments), adverse reactions (AR) - 6 cases (15% of appointments), remission - 1 case (2.5% of appointments). In the 2nd line of therapy, INF was prescribed in only 3 cases, the drug was canceled in all cases due to IE. In 3 lines of therapy, INF was prescribed in 4 cases, the reasons for withdrawal in these cases were IE (50%, 2 cases) and AR (50%, 2 cases). Etanercept (ETC ) was prescribed as the first line of therapy in 10 cases. The most common reason for withdrawal was IE in 5 cases (50% of appointments), AR - 4 cases (40%), AdmR - 1 case (10%). ETC was prescribed as a 2 line in 15 cases, the reasons for withdrawal then were: IE - 11 cases (73.3%), AR - 1 case (6.7%), AdmR - 3 cases (20%). ETC was prescribed as a 3-line therapy in 20 cases. The reasons for withdrawal were as follows: IE - 8 cases (40%), AR - 4 cases (20%), AdmR - 8 cases (40%). As a drug of 4 lines of therapy, ETC was prescribed 1 time and was canceled due to the development of AR. As the 5th line, ETC was appointed in 1 case and was canceled due to IE. ETC was assigned as line 6 in 1 case. The reason for the withdrawal was AR. Adalimumab (ADA ) was prescribed as the first line of therapy in 19 cases, the reasons for withdrawal were: IE - 14 cases (73.7%), AR - 2 cases (10.5%), AdmR - 3 (15.8%). On line 2, ADA made 20 appointments, the reasons for withdrawal were: IE - 13 (65%), AR - 3 (15%), AdmR - 4 (20%). ADA was prescribed as line 3 in 8 cases, the reasons for withdrawal were: IE - 6 (75%), AR - 1 (12.5%), AdmR - 1 (12.5%). As a 4-line drug, ADA was prescribed in 4 cases and was canceled in all cases due to IE. On line 5, ADA was assigned 1 time and was discontinuation due to IE. Golimumab (GLM). He was appointed as the first line in 5 cases. The reasons for withdrawal were: IE - 1 case (20%), AdmR - 4 appointments (80%). As a 2-line drug, GLM was prescribed once and was canceled due to AdmR. The drug was not prescribed for the 3rd and 4th lines. As a 5-line therapy, it was prescribed once and was canceled due to IE. When assessing the frequency of drug withdrawal due to IE or AR, no significant differences were found between the lines of therapy. Discontinuation rates were also not statistically different in the study groups. Conclusion: The most common reason for the withdrawal of TNF-α in patients with RRA is IE. With an increase in the lines of TNF-α therapy, remission as a reason for withdrawal was not identified. As a result of the increase in the number of sequentially prescribed bDMARDs, the frequency of discontinuation of TNF-α in connection with IE did not decrease. A significant reason for cancellation is AdmR, to which we attributed the absence of the drug in the pharmacy network, financial reasons limiting the continuation o Disclosure of Interests: None declared