Biological and targeted-synthetic disease-modifying anti-rheumatic drugs with concomitant methotrexate or leflunomide in rheumatoid arthritis: real-life TReasure prospective data
Gezmiş KimyonUmut KalyoncuSedat KirazCemal BeşNihan CoşkunBurcu YağızOrhan KüçükşahinNilüfer Alpay KanıtezAbdülsamet ErdenLevent KılıçEmre BılgınTimuçin KaşifoğluHakan EmmungilSüleyman Serdar KocaServet AkarMuhammet ÇınarVeli YazısızAşkın AteşDuygu ErsözlüEmel GönüllüRıdvan Mercanİhsan Ertenli
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Leflunomide
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This study examined real-world etanercept and adalimumab treatment patterns in patients with psoriasis, psoriatic arthritis, or both.This retrospective analysis utilized data from patients with psoriasis, psoriatic arthritis, or both from a large, US claims database. Outcome measures included persistence on index therapy; pauses (7-59 days) and gaps (≥60 days) in therapy; and rates of discontinuing, switching and restarting index therapy in nonpersistent patients.Of 4,453 patients, 2,534 initiated etanercept and 1,919 initiated adalimumab. In psoriasis patients (n = 2,775), 46.4% and 56.8% on etanercept and adalimumab, respectively, were persistent for ≥12 months, 49.0% and 56.3% discontinued, 23.8% and 22.4% restarted and 14.9% and 11.3% switched index therapy within 12 months. In psoriatic arthritis patients (n = 1,197), 60.7% and 63.3% on etanercept and adalimumab, respectively, were persistent for ≥12 months, 48.3% and 51.6% discontinued, 25.8% and 20.0% restarted and 16.5% and 17.9% switched index therapy. In patients with both (n = 481), 58.1% and 59.6% on etanercept and adalimumab, respectively, were persistent for ≥12 months, 42.7% and 63.2% discontinued, 24.3% and 12.6% restarted and 21.4% and 15.8% switched index therapy.Treatment modifications were common in patients with psoriasis, psoriatic arthritis, or both within 12 months of initiating etanercept or adalimumab.
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Infliximab and adalimumab are considered effective drugs in the management of Crohn's disease. However, due to significant immunossupression, they can cause important adverse events, mostly infections.The aim of this study was to quantify and describe adverse events derived from adalimumab and infliximab use in Crohn's disease patients, and to compare the safety profile between these two agents.This was an observational, single-center, longitudinal, retrospective study with Crohn's disease patients under infliximab or adalimumab therapy. Variables analyzed: demographic characteristics (including the Montreal classification), type of agent used, concomitant immunomodulators, presence and types of adverse events observed. Patients were allocated in two groups (infliximab and adalimumab) and had their adverse events accessed and subsequently compared.A total of 130 patients were included (68 in infliximab and 62 in adalimumab groups, respectively). The groups were fully homogeneous in all baseline characteristics, with a median follow-up of 47.21±36.52 months in the infliximab group and 47.79±35.09 in the adalimumab group (P=0.512). Adverse events were found in 43/68 (63.2%) and 40/62 (64.5%) in each group, respectively (P=0.879). There were no differences between the groups regarding infections (P=0.094) or treatment interruption (P=0.091). There were higher rates of infusion reactions in the infliximab group (P=0.016). Cephalea and injection site reactions were more prevalent in adalimumab patients.Adverse events were found in approximately two thirds of Crohn's disease patients under anti-TNF therapy, and there were no significant differences between infliximab or adalimumab.
Single Center
Concomitant
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Objectives: The objective of this study was to calculate adherence, persistence and 10-year switches in patients with PsA, by comparing adalimumab and etanercept in real life.Methods: The authors conducted a retrospective, observational, pharmacological and non-interventional study taking into consideration the dispensations of the study drugs at the Hospital Pharmacy, from 1 January 2007 to 31 December 2018. In the study, the authors considered adalimumab and etanercept. The authors calculated adherence to treatment through the relationship between received daily dose (RDD) and prescribed daily dose (PDD), and calculated persistence to treatment as the difference in days between the first and last dispensation.Results: The authors enrolled 113 patients, 60 treated with adalimumab and 53 with etanercept. Adherence levels were 0.83 for adalimumab and 0.84 for etanercept. Switches occurred in 42% of adalimumab and in 47% of etanercept prescriptions.Conclusion: In the treatment of PsA, persistence and switches are a problem for patients who cannot follow a consistent therapy over time, for clinicians who have to manage therapy suspension and changes, and for the National Health System that must procure and pay for a high number of drugs without information on their real value in terms of efficacy and safety of use.
Golimumab
Persistence (discontinuity)
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To evaluate the effectiveness of infliximab as a second-line therapy in Crohn's disease patients after adalimumab failure.A historical cohort study in a community-based gastroenterology practice evaluated Crohn's disease patients treated with infliximab (induction plus maintenance) after adalimumab failure. Patients were identified using a large Spanish database (ENEIDA).We included 15 Crohn's disease patients who received infliximab after adalimumab failure. Five patients discontinued adalimumab due to loss of response, 3 due to adverse events and 7 due to partial response. After infliximab therapy was started, all patients who had interrupted adalimumab due to loss of efficacy regained response. All patients who discontinued adalimumab due to adverse events responded to infliximab and maintained this response; one of these patients had an uneventful course on infliximab, but 2 developed adverse events. None of the 7 patients who interrupted adalimumab due to partial response reached remission with infliximab.Switching from adalimumab to infliximab may be useful in patients who develop adverse effects or loss of response, however, the benefit of infliximab in primary nonresponders was not established.
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The aim of this study was to evaluate medication adherence and persistence of patients treated with Etanercept and Adalimumab for Rheumatoid Arthritis, also giving economic evaluations on therapy costs for Received Daily Dose (RDD).This retrospective study took into account 6 years from January 1, 2007 to December 31, 2012. Medication adherence was quantified utilizing the ratio between RDD and Prescribed Daily Dose (PDD). Persistence has been reckoned taking into account the actual days of therapy comparing posology with supplied dose. The persistence has been graphed according to Kaplan-Meier method. The cost per RDD was reckoned starting from the expense incurred by Pescara General Hospital.Medication adherence gave results in values between 0.88-0.97 for Etanercept and 0.83-0.90 for Adalimumab. The value of persistence was 100% for Etanercept and 90% for Adalimumab for the first year, and 70% for Etanercept and 80% for Adalimumab for the second year. In the 3rd year the persistence for Etanercept was 50% while for Adalimumab it was 60%. In the fourth year the persistence for Etanercept was 21% while for Adalimumab it was 27%. The statistical analysis was conducted using the Log rank test. The average cost per RDD was €32.97 for Etanercept and for Adalimumab it was €32.00 as an average of 6 years.The medication adherence was good for both Etanercept and Adalimumab. The rate of persistence decreased strictly in the fourth year of treatment. This data suggests the need for continuous monitoring of patients in treatment with TNF blockers.
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Abstract Background: Etanercept and adalimumab are the most widely used biologic agents for psoriasis today. Large phase III trials have elucidated the much higher efficacy of adalimumab over etanercept; however, no head-to-head comparison data exist for these two medications. Objective: We report four cases of patients well controlled with Enbrel who flared when switched to adalimumab. In all four cases, the patient's psoriasis improved when switched back to etanercept. Conclusion: This brief report is intended to alert clinicians of the possibility that, despite the well-known average efficacy advantage of adalimumab over etanercept, some psoriasis patients experience better clinical outcome with etanercept than adalimumab. Therefore, despite the general efficacy difference between these two TNF inhibitors, it may be worth keeping in mind etanercept as an option in patients who have failed with adalimumab.Key words:: adalimumabEnbreletanerceptHumirapsoriasis Declaration of interest: Dr Bhutani has no financial conflicts of interest to report. Dr Koo has been a clinical researcher, consultant, and speaker for Abbott, Allergan, Amgen, Astellas, Galderma, Genentech, JSJ, Photomedex, Roche, Warner-Chilcott, and Teikoku.
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瞄准：在 adalimumab 失败以后在 Crohns 疾病病人作为第二线的治疗评估 infliximab 的有效性。方法：在一个基于社区的肠胃病学惯例的历史的队研究评估了在 adalimumab 失败以后与 infliximab (加维护的正式就职) 对待的 Crohns 疾病病人。病人们用一个大西班牙的数据库(ENEIDA ) 被识别。结果：我们包括了在 adalimumab 失败以后收到了 infliximab 的 15 个 Crohns 疾病病人。五个病人由于反应的损失中止了 adalimumab， 3 由于不利事件并且 7 由于部分反应。在 infliximab 治疗被开始以后，由于功效的损失打断了 adalimumab 的所有病人重获反应。由于不利事件中止了 adalimumab 的所有病人对 infliximab 作出回应并且维持了这回答；这些病人之一在 infliximab 上有一堂平静功课，但是 2 开发了不利事件。任何一个都没与 infliximab 由于部分反应打断了 adalimumab 的 7 个病人到达宽恕。结论：从 adalimumab 切换到 infliximab 可能在然而，开发反应的不利效果或损失的病人是有用的在主要 nonresponders 的 infliximab 的利益没被建立。
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This retrospective multicentre analysis from the Psoriasis Registry Austria (PsoRA) was conducted to determine drug effectiveness and survival of anti-tumour necrosis factor alpha (anti-TNF-α) agents in patients with moderate-to-severe chronic plaque psoriasis over a 9-year period. Data on 1,019 treatment cycles with adalimumab (n = 460), etanercept (n = 501), and/or infliximab (n = 58) administered to 827 patients (272 women, 555 men) were available for analysis. Compared with etanercept, adalimumab and infliximab showed superior short-term effectiveness. Intention-to-treat-calculated median drug survivals for adalimumab (1,264 days) and etanercept (1,438 days) were similar to each other (p = 0.74), but significantly superior to that of infliximab (477 days) (p = 7.0e-07 vs. adalimumab and p=2.2e-07 vs. etanercept, respectively). Their drug survival rates at 36 months were 51.6%, 56.0%, and 22.6%, respectively. Survival rates correlated significantly with effectiveness for adalimumab and etanercept, but not for infliximab.
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