Incidence and risk factors of discontinuation of tofacitinib and biologic disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis: A population-based cohort study.

Autor: Shih PC; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, No. 135, NanXiao Street, Changhua, 500, Taiwan. robertpcshih@gmail.com.; Institute of Medicine, Chung Shan Medical University, South District, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 40201, Taiwan. robertpcshih@gmail.com., Hung PC; School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan., Leong PY; Institute of Medicine, Chung Shan Medical University, South District, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 40201, Taiwan.; Department of Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan.; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan.; PhD Program in Business, Feng Chia University, Taichung, 407, Taiwan., Hsu JN; School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.; Department of Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan., Yang CC; School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan., Wei JCC; Institute of Medicine, Chung Shan Medical University, South District, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 40201, Taiwan. jccwei@gmail.com.; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan. jccwei@gmail.com.; Graduate Institute of Integrated Medicine, China Medical University, Taichung, 402, Taiwan. jccwei@gmail.com.; Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China. jccwei@gmail.com.; Office of Research and Development, Asia University, Taichung, Taiwan. jccwei@gmail.com., Chen HH; Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Xitun District, No. 1650, Sec. 4, Taiwan Blvd., Taichung, 40705, Taiwan. shc5555@hotmail.com.; National Chung Hsing University, Taichung, 402, Taiwan. shc5555@hotmail.com.
Jazyk: angličtina
Zdroj: Clinical rheumatology [Clin Rheumatol] 2024 Dec; Vol. 43 (12), pp. 3625-3637. Date of Electronic Publication: 2024 Oct 11.
DOI: 10.1007/s10067-024-07161-6
Abstrakt: To investigate the incidence of the discontinuation among tofacitinib and biologic disease-modifying anti-rheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). This retrospective population-based cohort study included 5,008 RA patients who initiated treatment with either tofacitinib or bDMARDs (etanercept, adalimumab, golimumab, tocilizumab, or abatacept) between January 1, 2014, and December 31, 2020. We conducted Cox proportional hazards regression and subsequent time-dependent regression to assess the risk of drug discontinuation, with adjustments for potential variables. The highest drug discontinuation rate was observed with etanercept (43.27%), while the lowest was with tofacitinib (21.8%). Tofacitinib was associated with a significantly lower risk of discontinuation compared to etanercept (HR: 0.67, 95% CI: 0.57-0.80) and other bDMARDs. Higher steroid dosage and the presence of concomitant connective tissue diseases were significant risk factors for drug discontinuation. Conversely, the use of methotrexate was associated with a reduced risk of discontinuation. Tofacitinib demonstrated a lower risk of drug discontinuation compared to TNFi, with the risk factors for discontinuation including higher steroid dosage and concomitant connective tissue diseases. The study highlights the importance of considering several potential risk factors in drug discontinuation. Key Points • Non-TNFi biologic agents demonstrated better drug retention than TNFi among patients diagnosed with rheumatoid arthritis, with tofacitinib showing the lowest discontinuation rate (21.8%), underscoring its potential for superior drug retention in rheumatoid arthritis management. • Several factors were associated with drug discontinuation: higher steroid dosage and concomitant connective tissue diseases were linked to a higher discontinuation rate, whereas the concomitant use of methotrexate was associated with a lower risk of discontinuation.
Competing Interests: Compliance with ethical standards. Ethics approval: This study was approved by Institutional Review Board of Chung Shan Medical University Hospital. (Approval number: CS19159). Disclosures: None
(© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)
Databáze: MEDLINE
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