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Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry

In this study we aimed to identify the predictors of drug survival for biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) among patients with rheumatoid arthritis (RA) in a real-world setting. Data from RA patients receiving bDMARDs and tsDMARDs between 2007 and 2019 were extracted from t...

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Autores principales: Lin, Ching-Tsai, Huang, Wen-Nan, Tsai, Wen-Chan, Chen, Jun-Peng, Hung, Wei-Ting, Hsieh, Tsu-Yi, Chen, Hsin-Hua, Hsieh, Chia-Wei, Lai, Kuo-Lung, Tang, Kuo-Tung, Tseng, Chih-Wei, Chen, Der-Yuan, Chen, Yi-Hsin, Chen, Yi-Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087098/
https://www.ncbi.nlm.nih.gov/pubmed/33930048
http://dx.doi.org/10.1371/journal.pone.0250877
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author Lin, Ching-Tsai
Huang, Wen-Nan
Tsai, Wen-Chan
Chen, Jun-Peng
Hung, Wei-Ting
Hsieh, Tsu-Yi
Chen, Hsin-Hua
Hsieh, Chia-Wei
Lai, Kuo-Lung
Tang, Kuo-Tung
Tseng, Chih-Wei
Chen, Der-Yuan
Chen, Yi-Hsin
Chen, Yi-Ming
author_facet Lin, Ching-Tsai
Huang, Wen-Nan
Tsai, Wen-Chan
Chen, Jun-Peng
Hung, Wei-Ting
Hsieh, Tsu-Yi
Chen, Hsin-Hua
Hsieh, Chia-Wei
Lai, Kuo-Lung
Tang, Kuo-Tung
Tseng, Chih-Wei
Chen, Der-Yuan
Chen, Yi-Hsin
Chen, Yi-Ming
author_sort Lin, Ching-Tsai
collection PubMed
description In this study we aimed to identify the predictors of drug survival for biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) among patients with rheumatoid arthritis (RA) in a real-world setting. Data from RA patients receiving bDMARDs and tsDMARDs between 2007 and 2019 were extracted from the Taiwan Rheumatology Association Clinical Electronic Registry (TRACER). Patients were categorized into tumor necrosis factor-alpha (TNF-α) inhibitors, non-TNF-α inhibitors, and tofacitinib groups. The primary outcome was 3-year drug retention and the causes of bDMARDs and tsDMARDs discontinuation were recorded. Baseline demographic data before the initiation of bDMARDs and tsDMARDs treatment were analyzed to identify the predictors of 3-year drug survival. A total of 1,270 RA patients were recruited (TNF-α inhibitors: 584; non-TNF-α inhibitors: 535; tofacitinib: 151). The independent protective factors for 3-year drug survival were positive rheumatoid factor (RF) (HR: 0.48, 95% CI: 0.27–0.85, p = 0.013) and biologics-naïve RA (HR: 0.61, 95% CI: 0.39–0.94, p = 0.024). In contrast, positive anti-citrullinated protein antibody (ACPA) (HR: 2.24, 95% CI: 1.32–3.79, p = 0.003) and pre-existing latent tuberculosis (HR: 2.90, 95% CI: 2.06–4.09, p<0.001) were associated with drug discontinuation. RA patients treated with TNF-α inhibitors exhibited better drug retention, especially in the biologics-naïve subgroup (p = 0.037). TNF-α inhibitors were associated with lower cumulative incidence of discontinuation due to inefficacy and adverse events (both p<0.001). Baseline RF and ACPA positivity in abatacept-treated patients were associated with a better 3-year drug survival. However, negative ACPA levels predicted superior drug survival of TNF-α inhibitors and tofacitinib. In conclusion, bio-naïve status predicted better drug survival in TNF-α inhibitors-treated RA patients. RF and ACPA positivity predicted better abatacept drug survival. In contrast, ACPA negativity was associated with superior TNF-α inhibitors and tofacitinib survival.
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spelling pubmed-80870982021-05-06 Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry Lin, Ching-Tsai Huang, Wen-Nan Tsai, Wen-Chan Chen, Jun-Peng Hung, Wei-Ting Hsieh, Tsu-Yi Chen, Hsin-Hua Hsieh, Chia-Wei Lai, Kuo-Lung Tang, Kuo-Tung Tseng, Chih-Wei Chen, Der-Yuan Chen, Yi-Hsin Chen, Yi-Ming PLoS One Research Article In this study we aimed to identify the predictors of drug survival for biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) among patients with rheumatoid arthritis (RA) in a real-world setting. Data from RA patients receiving bDMARDs and tsDMARDs between 2007 and 2019 were extracted from the Taiwan Rheumatology Association Clinical Electronic Registry (TRACER). Patients were categorized into tumor necrosis factor-alpha (TNF-α) inhibitors, non-TNF-α inhibitors, and tofacitinib groups. The primary outcome was 3-year drug retention and the causes of bDMARDs and tsDMARDs discontinuation were recorded. Baseline demographic data before the initiation of bDMARDs and tsDMARDs treatment were analyzed to identify the predictors of 3-year drug survival. A total of 1,270 RA patients were recruited (TNF-α inhibitors: 584; non-TNF-α inhibitors: 535; tofacitinib: 151). The independent protective factors for 3-year drug survival were positive rheumatoid factor (RF) (HR: 0.48, 95% CI: 0.27–0.85, p = 0.013) and biologics-naïve RA (HR: 0.61, 95% CI: 0.39–0.94, p = 0.024). In contrast, positive anti-citrullinated protein antibody (ACPA) (HR: 2.24, 95% CI: 1.32–3.79, p = 0.003) and pre-existing latent tuberculosis (HR: 2.90, 95% CI: 2.06–4.09, p<0.001) were associated with drug discontinuation. RA patients treated with TNF-α inhibitors exhibited better drug retention, especially in the biologics-naïve subgroup (p = 0.037). TNF-α inhibitors were associated with lower cumulative incidence of discontinuation due to inefficacy and adverse events (both p<0.001). Baseline RF and ACPA positivity in abatacept-treated patients were associated with a better 3-year drug survival. However, negative ACPA levels predicted superior drug survival of TNF-α inhibitors and tofacitinib. In conclusion, bio-naïve status predicted better drug survival in TNF-α inhibitors-treated RA patients. RF and ACPA positivity predicted better abatacept drug survival. In contrast, ACPA negativity was associated with superior TNF-α inhibitors and tofacitinib survival. Public Library of Science 2021-04-30 /pmc/articles/PMC8087098/ /pubmed/33930048 http://dx.doi.org/10.1371/journal.pone.0250877 Text en © 2021 Lin et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lin, Ching-Tsai
Huang, Wen-Nan
Tsai, Wen-Chan
Chen, Jun-Peng
Hung, Wei-Ting
Hsieh, Tsu-Yi
Chen, Hsin-Hua
Hsieh, Chia-Wei
Lai, Kuo-Lung
Tang, Kuo-Tung
Tseng, Chih-Wei
Chen, Der-Yuan
Chen, Yi-Hsin
Chen, Yi-Ming
Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
title Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
title_full Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
title_fullStr Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
title_full_unstemmed Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
title_short Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
title_sort predictors of drug survival for biologic and targeted synthetic dmards in rheumatoid arthritis: analysis from the tra clinical electronic registry
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087098/
https://www.ncbi.nlm.nih.gov/pubmed/33930048
http://dx.doi.org/10.1371/journal.pone.0250877
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