Long-term drug survival of tumor necrosis factor inhibitors in patients with rheumatoid arthritis

Objective Evaluate long-term drug survival (proportion of patients still receiving treatment) and discontinuation of etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab using observational data from patients with rheumatoid arthritis. Methods Following a systematic literature review, drug survival at 12 and 12–24 months of follow-up was estimated by summing proportions of patients remaining on treatment and dividing by number of studies. Drug survival at ≥36 months of follow-up was estimated via Metaprop. Results 170 publications were included. In the first-line setting, drug survival at 12 months with etanercept, infliximab, or adalimumab was 71%, 69%, and 70%, respectively, while at 12–24 months the corresponding rates were 63%, 57%, and 59%. In the second-line setting, drug survival at 12 months with etanercept, infliximab, or adalimumab was 61%, 69%, and 55%, respectively, while at 12–24 months the corresponding rates were 53%, 39%, and 43%. Drug survival at ≥36 months with etanercept, infliximab, or adalimumab in the first-line setting was 59% (95% confidence interval [CI]: 46–72%), 49% (95% CI: 43–54%), and 51% (95% CI: 41–60%), respectively, while in the second-line setting the corresponding rates were 56% (95% CI: 52–61%), 48% (95% CI: 40–55%), and 41% (95% CI: 36–47%). Discontinuation of etanercept, infliximab, and adalimumab at 36 months of follow-up was 38–48%, 42– 62%, and 38–59%, respectively. Data on certolizumab pegol and golimumab were scarce. Conclusion After >12 months of follow-up, more patients with rheumatoid arthritis receiving etanercept remain on treatment compared with other TNFi.