Discontinuation of anti-TNF-α therapy in a Chinese cohort of patients with rheumatoid arthritis
Clinical Rheumatology, 08/09/2012
Yang CT et al. – In the present study, a significant proportion of patients with rheumatoid arthritis discontinued anti–tumor necrosis factor (TNF) treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti–TNF treatment.Methods
- Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in the authors' institution from 2003 to 2010.
- Time to discontinuation of anti-TNF- α therapy was estimated using survival analysis techniques.
- The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients.
- The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years.
- The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4-87.0; median, 26.4 months).
- Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1).
- In patients with RA, older age ( ≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67-6.20; p < 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17-27.90; p = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75-8.35; p = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment.