Persistence on biologic DMARD monotherapy after achieving rheumatoid arthritis disease control on combination therapy: r
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Rheumatology International https://doi.org/10.1007/s00296-020-04667-5
INTERNATIONAL
OBSERVATIONAL RESEARCH
Persistence on biologic DMARD monotherapy after achieving rheumatoid arthritis disease control on combination therapy: retrospective analysis of corrona registry data Dimitrios A. Pappas1,2 · Heather J. Litman3 · Tamara Lesperance4 · Greg Kricorian5 · Elaine Karis5 · Sabrina Rebello1 · Winnie Hua3 · Neil A. Accortt6 · Scott Stryker6 Received: 3 February 2020 / Accepted: 28 July 2020 © The Author(s) 2020
Abstract Biological disease-modifying antirheumatic drugs (bDMARDs) monotherapy may enhance adherence and decrease adverse events compared to combination therapy with conventional synthetic DMARDs (csDMARDs); however, persistence with bDMARD monotherapy has not been extensively studied. We explore persistence of etanercept monotherapy and monotherapy with other tumor necrosis factor inhibitors (TNFis) among patients first achieving remission/low disease activity (LDA) while on combination therapy with csDMARDs and a TNFi. Using Corrona registry data, the percentage of patients persistent with the index TNFi (etanercept versus other TNFis) over 6 and 12 months was determined. Factors influencing persistence and treatment patterns at 6 and 12 months were examined. Among 617 eligible patients, 56% of 182 patients on etanercept and 45% of 435 patients on other TNFis persisted with monotherapy at 6 months, 46% and 33%, respectively, at 12 months. Across first-line and subsequent biologic DMARDs, etanercept persistence was greater than other TNFi persistence by 10.8% (95% CI 2.1%, 19.6%) at 6 months and 11.4% (95% CI 0.9%, 21.9%) at 12 months. Patients on other TNFis were more likely to require reintroduction of csDMARD after 6 months (45% versus 35% for etanercept). Remission was the key predictor of persistence for both etanercept and other TNFi monotherapies. This retrospective, cohort study of registry data reflecting real-world practice indicates patients who achieve remission/LDA with combination csDMARD and TNFi therapy may successfully transition to TNFi monotherapy. Patients on etanercept monotherapy experienced greater persistence and less frequent reintroduction of a csDMARD than was observed for patients on other TNFi monotherapies. Keywords TNF inhibitors · Etanercept · Methotrexate · Antirheumatic drugs · Disease-modifying antirheumatic drugs · Arthritis · Rheumatoid
* Dimitrios A. Pappas [email protected]
Scott Stryker [email protected]
Heather J. Litman [email protected]
1
Tamara Lesperance [email protected]
Department of Epidemiology and Outcomes Research, Corrona, LLC, Waltham, MA, USA
2
Greg Kricorian [email protected]
Columbia University College of Physicians and Surgeons, Columbia University, 630 W 168th St, P&S Building, Suite 10‑445, New York, NY 10032, USA
3
Elaine Karis [email protected]
Department of Biostatistics, Corrona, LLC, Waltham, MA, USA
4
DOCS Global, Inc., North Wales, PA, USA
5
US Medical Affairs, Amgen Inc., Thousand
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