Reasons for Discontinuation The Biological Treatment in Chronic Inflammatory Arthropathy
Martin Vila, A.; Melero Gonzalez, R.; Martinez Lopez de Catro, N.; Álvarez Payero, M.; Rodriguez, M.R.; Maceiras Pan, F.; Mouriño, C.; Rodríguez Lόpez, M.; Hernández Rodriguez, I.; Barbazán Álvarez, C.; Samartin Ucha, M.; Balboa Barreiro, Vanesa; de Uña-Álvarez, Jacobo; Piñeiro Corrales, G.; Pego Reigosa, J.M.
Objectives: To analyze the reasons for discontinuation the biological treatment in a cohort of patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PA), ankylosing spondylitis (AS) and other spondyloarthropathies (O) that have been treated with at least a biotech drug.
Methods: Retrospective observational study. All patients who had been treated with a biological drug for at least six months during the period between 01/01/2009 and 31/08/2014, for any of the previously specified indications were included. In addition to demographic data, all lines of treatment received from the diagnosis, and the reasons for discontinuation of those lines were analyzed. The adverse events categorized as reasons to treatment discontinuation were collected. The relationship between the reasons for discontinuation and the biological treatment was explored.
Results: We studied 484 patients with a mean age of 56 years (SD 14.4), 54.3% women. Disease distribution: 49% RA,21.5% PA, 22.6% AS and 6.9%O.Drug distribution:adalimumab 45.7% of patients,etanercept 29%,infliximab 12.7%,golimumab 2.6%,certolizumab 0.8%, abatacept 2.6%, rituximab 3.4% and tocilizumab 3%.Of a total of 765 lines of treatment, were analyzed all the finished lines:365.The reasons for discontinuation were:42.5% secondary failure,22.7% side effects,10.7% primary failure,6% clinical remission,1.9%, exitus, nonadherence 0.3% and other reasons for discontinuation 15.9%.Significant differences (p<0.05) were observed in the distribution of reasons for discontinuation based on biological treatment used.All comparisons between different drugs 2–2 were performed for each of the reasons for discontinuation, and the following differences were found.When adalimumab versus etanercept and versus infliximab is compare, it is more frequent the reason for discontinuation “clinical remission” in adalimumab than in etanercept or infliximab (p<0.05).When comparing etanercept versus infliximab is more often the reason for discontinuation “primary failure” with etanercept (p<0.01).
In the 50% of patients (P) with rituximab and in the 38.5% of P with abatacept the reason for discontinuation was an adverse event (AE), compared with 19% in adalimumab, 19.6% etanercept and 26.3% infliximab. Regarding the AE that were a cause for discontinuation:infusion reaction in 19P,general symptoms in 16P,bacterial infection in 12P,other types of skin toxicity 11P,anaphylaxis in 8P,liver toxicity in 4P,hematologic tumor in 2P,tuberculosis in 2P,psoriasiform reaction 2P,viral infectiόn 2P,interstitial disease 1P,solid tumor in 1P,psychiatric disorders in 1P,lipid abnormalities 1P,hematologic toxicity 1P and not collected in history in 2P.
Conclusions: The most common reason for discontinuation was ""secondary failure"" followed by “AE”,highlighting the infusion-related reactions and bacterial infections.The frequency of several of the reasons for discontinuation of treatment is different depending on the biological drug used.