Discontinuation of biologic therapy due to lack/loss of response and adverse events is similar between TNFi and non-TNFi class: Results from a real-world rheumatoid arthritis cohort

Mohammad Movahedi; Elliot Hepworth; Reza Mirza; Angela Cesta; Maggie Larche; Claire Bombardier

doi:10.1016/j.semarthrit.2020.06.020

Discontinuation of biologic therapy due to lack/loss of response and adverse events is similar between TNFi and non-TNFi class: Results from a real-world rheumatoid arthritis cohort

Semin Arthritis Rheum. 2020 Oct;50(5):915-922. doi: 10.1016/j.semarthrit.2020.06.020. Epub 2020 Jul 14.

Authors

Mohammad Movahedi¹, Elliot Hepworth², Reza Mirza³, Angela Cesta⁴, Maggie Larche⁵, Claire Bombardier⁶

Affiliations

¹ Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: mmovahed@uhnresearch.ca.
² Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
⁵ Divisions of Rheumatology and Clinical Immunology and Allergy, Departments of Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada.
⁶ Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine (DOM) and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada. Electronic address: claire.bombardier@utoronto.ca.

PMID: 32911288
DOI: 10.1016/j.semarthrit.2020.06.020

Abstract

Objectives: Time to discontinuation of biologic therapy may be related to mechanism of action. We aimed to compare discontinuation of tumor necrosis factor inhibitors (TNFi) versus non-TNFi in an observational rheumatoid arthritis cohort.

Methods: Patients enrolled in the Ontario Best Practices Research Initiative (OBRI) starting biologic agents on or after 1st January 2010 were included. Time to discontinuation due to (1) any reason, (2) any of lack/loss of response, adverse events (AEs), physician, or patient decision, (3) lack/loss of response, and (4) AEs were assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis.

Results: A total of 932 patients were included of whom 174 (18.7%) received non-TNFi and 758 (81.3%) received TNFi. Over a median follow-up of 1.7 years, discontinuation was reported for 416 (44.6%) due to any reason, 367 (39.4%) due to any of lack/loss of response, AEs, physician, or patient decision, 192 (20.6%) due to lack/loss of response, and 102 (10.9%) due to AEs. After adjusting for propensity score, there was no significant difference in discontinuation between the two classes due to any reason [HR 1.14 (0.90-1.46), p = 0.28], lack/loss of response [HR: 1.01 (0.70-1.47), p = 0.95], and AEs [HR: 1.06 (0.64-1.73), p = 0.83]. Similar results were found in biologic naïve patients.

Conclusions: This analysis demonstrates that discontinuation of therapy is similar in patients started on TNFi and non-TNFi therapies. There was also no significant difference in stopping due to lack/loss of response or AEs, suggesting that these reasons should not drive the selection of one treatment over another.

Keywords: Discontinuation; Rheumatoid arthritis; TNF; Treatment; bDMARDs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / adverse effects
Arthritis, Rheumatoid* / drug therapy
Biological Therapy
Humans
Registries
Treatment Outcome
Tumor Necrosis Factor Inhibitors
Tumor Necrosis Factor-alpha / therapeutic use

Substances

Antirheumatic Agents
Tumor Necrosis Factor Inhibitors
Tumor Necrosis Factor-alpha