Sofie H M Manders1, Wietske Kievit2, Tim L T A Jansen2, Jan N Stolk2, Henk Visser2, Annemarie M Schilder2, Harald E Vonkeman2, Eddy Adang2, Mart A F J van de Laar2, Piet L C M van Riel2. 1. From the Department of IQ Healthcare, the Department of Health Evidence, the Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen; Rheumatology, Ziekenhuis Gelderse Vallei, Ede; Rheumatology, Rijnstate, Arnhem; Rheumatology, Medical Centre Leeuwarden, Leeuwarden; Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, the Netherlands.S.H. Manders, MSc, Department of IQ Healthcare, Radboud University Medical Center; W. Kievit, PhD, Department of Health Evidence, Radboud University Medical Center; T.L. Jansen, PhD, Department of Rheumatic Diseases, Radboud University Medical Center; J.N. Stolk, PhD, Rheumatology, Ziekenhuis Gelderse Vallei; H. Visser, PhD, Rheumatology, Rijnstate; A.M. Schilder, MD, Rheumatology, Medical Centre Leeuwarden; H.E. Vonkeman, PhD, Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente; E. Adang, PhD, Department of Health Evidence, Radboud University Medical Center; M.A. van de Laar, Professor, Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.L. van Riel, Professor, Department of IQ Healthcare, Radboud University Medical Center. sofie.manders@radboudumc.nl. 2. From the Department of IQ Healthcare, the Department of Health Evidence, the Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen; Rheumatology, Ziekenhuis Gelderse Vallei, Ede; Rheumatology, Rijnstate, Arnhem; Rheumatology, Medical Centre Leeuwarden, Leeuwarden; Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, the Netherlands.S.H. Manders, MSc, Department of IQ Healthcare, Radboud University Medical Center; W. Kievit, PhD, Department of Health Evidence, Radboud University Medical Center; T.L. Jansen, PhD, Department of Rheumatic Diseases, Radboud University Medical Center; J.N. Stolk, PhD, Rheumatology, Ziekenhuis Gelderse Vallei; H. Visser, PhD, Rheumatology, Rijnstate; A.M. Schilder, MD, Rheumatology, Medical Centre Leeuwarden; H.E. Vonkeman, PhD, Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente; E. Adang, PhD, Department of Health Evidence, Radboud University Medical Center; M.A. van de Laar, Professor, Arthritis Centre Twente, Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.L. van Riel, Professor, Department of IQ Healthcare, Radboud University Medical Center.
Abstract
OBJECTIVE: To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice. METHODS: Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders. RESULTS: The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value. CONCLUSION: Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.
OBJECTIVE: To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice. METHODS: Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders. RESULTS: The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value. CONCLUSION: Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.
Authors: C Fiehn; J Holle; C Iking-Konert; J Leipe; C Weseloh; M Frerix; R Alten; F Behrens; C Baerwald; J Braun; H Burkhardt; G Burmester; J Detert; M Gaubitz; A Gause; E Gromnica-Ihle; H Kellner; A Krause; J Kuipers; H-M Lorenz; U Müller-Ladner; M Nothacker; H Nüsslein; A Rubbert-Roth; M Schneider; H Schulze-Koops; S Seitz; H Sitter; C Specker; H-P Tony; S Wassenberg; J Wollenhaupt; K Krüger Journal: Z Rheumatol Date: 2018-08 Impact factor: 1.372
Authors: Kaleb Michaud; Bernard Vrijens; Eric Tousset; Sofia Pedro; Rebecca Schumacher; Gorana Dasic; Connie Chen; Ekta Agarwal; Maria E Suarez-Almazor Journal: ACR Open Rheumatol Date: 2019-09-06
Authors: Ettore Silvagni; Alessandra Bortoluzzi; Greta Carrara; Anna Zanetti; Marcello Govoni; Carlo Alberto Scirè Journal: BMJ Open Date: 2018-09-11 Impact factor: 2.692
Authors: Martina Skácelová; Lucie Nekvindová; Heřman Mann; Jakub Závada; Zlatuše Křístková; Jiří Vencovský; Karel Pavelka; Pavel Horák Journal: Rheumatol Int Date: 2022-03-26 Impact factor: 2.631