Drug Persistence and Incidence of Active Tuberculosis of Tumor Necrosis Factor Alpha Inhibitors Versus Tocilizumab as the First-Line Biological Treatment in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Retrospective Cohort Analysis
- PMID: 38769252
- DOI: 10.1007/s40744-024-00674-1
Drug Persistence and Incidence of Active Tuberculosis of Tumor Necrosis Factor Alpha Inhibitors Versus Tocilizumab as the First-Line Biological Treatment in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Retrospective Cohort Analysis
Abstract
Introduction: Drug persistence may be a surrogate marker that reflects both long-term efficacy and safety in clinical settings, and tuberculosis (TB) is considered as one of the most important opportunistic infections after the biological treatment in rheumatoid arthritis (RA). We aimed to compare drug persistence and incidence of TB between tumor necrosis factor alpha (TNFα) inhibitors and tocilizumab in patients with RA using data from the Korean Health Insurance Review and Assessment Service database.
Methods: In this analysis, 5449 patients with RA who started TNFα inhibitors, such as adalimumab, etanercept, infliximab, and golimumab or tocilizumab, as the first-line biological therapy between January 2014 and December 2017 were analyzed and followed up until December 2019. Drug persistence was defined as the duration from initiation to first discontinuation, and TB was defined as the prescription of > 2 anti-TB medications after the initiation of biologics.
Results: TNFα inhibitors and tocilizumab were prescribed in 4202 (adalimumab, 1413; etanercept, 1100; infliximab, 769; golimumab 920) and 1247 patients with RA, respectively. During the analysis period, 2090 (49.7%) and 477 (38.3%) patients with RA discontinued TNFα inhibitors and tocilizumab, respectively, and 42 patients with RA developed TB (TNFα inhibitors, 33; tocilizumab, 9). After adjustment for confounding factors, TNFα inhibitors were significantly associated with a higher risk of discontinuation compared with tocilizumab (hazard ratio (HR) 1.63, p < 0.001). In subgroup analysis, all types of TNFα inhibitors, except for infliximab, demonstrated a significantly lower persistence rate compared with tocilizumab. There was no significant difference in TB incidence between tocilizumab and TNFα inhibitors. In subgroup analysis, infliximab has a significantly higher risk of TB compared with tocilizumab (HR 2.84, p = 0.02).
Conclusion: In this analysis, tocilizumab had longer persistence than TNFα inhibitors with a similar incidence of TB. Our analysis has limitations: (1) The HIRA database lacks clinical details like disease activity and joint damage extent, potentially influencing the analysis results. (2) Reasons for discontinuing biological agents were not available. (3) TB diagnoses may be inaccurate because of missing microbiological results. (4) We did not analyze the impact of treating latent TB infection on TB development post-biological treatment, despite mandatory screening in Korea.
Keywords: Monoclonal antibodies; Mycobacterium infections; Rheumatoid arthritis; Treatment adherence and compliance.
© 2024. The Author(s).
Similar articles
-
Comparison of developing tuberculosis following tumor necrosis factor inhibition and interleukin-6 inhibition in patients with rheumatoid arthritis: a nationwide observational study in South Korea, 2013-2018.Arthritis Res Ther. 2022 Jun 27;24(1):157. doi: 10.1186/s13075-022-02842-6. Arthritis Res Ther. 2022. PMID: 35761359 Free PMC article.
-
Screening for acquired latent tuberculosis in rheumatoid arthritis patients on tumor necrosis factor inhibition therapy in Southern California.Clin Rheumatol. 2020 Aug;39(8):2291-2297. doi: 10.1007/s10067-020-04991-y. Epub 2020 Feb 28. Clin Rheumatol. 2020. PMID: 32112272
-
Down-titration and discontinuation strategies of tumor necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity.Cochrane Database Syst Rev. 2014 Sep 29;(9):CD010455. doi: 10.1002/14651858.CD010455.pub2. Cochrane Database Syst Rev. 2014. Update in: Cochrane Database Syst Rev. 2019 May 24;5:CD010455. doi: 10.1002/14651858.CD010455.pub3. PMID: 25264908 Updated. Review.
-
Safe re-administration of tumor necrosis factor-alpha (TNFα) inhibitors in patients with rheumatoid arthritis or ankylosing spondylitis who developed active tuberculosis on previous anti-TNFα therapy.J Korean Med Sci. 2014 Jan;29(1):38-42. doi: 10.3346/jkms.2014.29.1.38. Epub 2013 Dec 26. J Korean Med Sci. 2014. PMID: 24431903 Free PMC article.
-
A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness.Health Technol Assess. 2006 Nov;10(42):iii-iv, xi-xiii, 1-229. doi: 10.3310/hta10420. Health Technol Assess. 2006. PMID: 17049139 Review.
References
LinkOut - more resources
Full Text Sources