PMID- 32911288
OWN - NLM
STAT- MEDLINE
DCOM- 20210929
LR  - 20210929
IS  - 1532-866X (Electronic)
IS  - 0049-0172 (Linking)
VI  - 50
IP  - 5
DP  - 2020 Oct
TI  - Discontinuation of biologic therapy due to lack/loss of response and adverse 
      events is similar between TNFi and non-TNFi class: Results from a real-world 
      rheumatoid arthritis cohort.
PG  - 915-922
LID - S0049-0172(20)30202-X [pii]
LID - 10.1016/j.semarthrit.2020.06.020 [doi]
AB  - OBJECTIVES: Time to discontinuation of biologic therapy may be related to 
      mechanism of action. We aimed to compare discontinuation of tumor necrosis factor 
      inhibitors (TNFi) versus non-TNFi in an observational rheumatoid arthritis 
      cohort. METHODS: Patients enrolled in the Ontario Best Practices Research 
      Initiative (OBRI) starting biologic agents on or after 1st January 2010 were 
      included. Time to discontinuation due to (1) any reason, (2) any of lack/loss of 
      response, adverse events (AEs), physician, or patient decision, (3) lack/loss of 
      response, and (4) AEs were assessed using Kaplan-Meier survival and Cox 
      proportional hazards regression analysis. RESULTS: A total of 932 patients were 
      included of whom 174 (18.7%) received non-TNFi and 758 (81.3%) received TNFi. 
      Over a median follow-up of 1.7 years, discontinuation was reported for 416 
      (44.6%) due to any reason, 367 (39.4%) due to any of lack/loss of response, AEs, 
      physician, or patient decision, 192 (20.6%) due to lack/loss of response, and 102 
      (10.9%) due to AEs. After adjusting for propensity score, there was no 
      significant difference in discontinuation between the two classes due to any 
      reason [HR 1.14 (0.90-1.46), p = 0.28], lack/loss of response [HR: 1.01 
      (0.70-1.47), p = 0.95], and AEs [HR: 1.06 (0.64-1.73), p = 0.83]. Similar results 
      were found in biologic naive patients. CONCLUSIONS: This analysis demonstrates 
      that discontinuation of therapy is similar in patients started on TNFi and 
      non-TNFi therapies. There was also no significant difference in stopping due to 
      lack/loss of response or AEs, suggesting that these reasons should not drive the 
      selection of one treatment over another.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Movahedi, Mohammad
AU  - Movahedi M
AD  - Ontario Best Practices Research Initiative, Toronto General Research Institute, 
      University Health Network, Toronto, ON, Canada; Institute of Health Policy, 
      Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. 
      Electronic address: mmovahed@uhnresearch.ca.
FAU - Hepworth, Elliot
AU  - Hepworth E
AD  - Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada.
FAU - Mirza, Reza
AU  - Mirza R
AD  - Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, 
      ON, Canada.
FAU - Cesta, Angela
AU  - Cesta A
AD  - Ontario Best Practices Research Initiative, Toronto General Research Institute, 
      University Health Network, Toronto, ON, Canada.
FAU - Larche, Maggie
AU  - Larche M
AD  - Divisions of Rheumatology and Clinical Immunology and Allergy, Departments of 
      Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada.
FAU - Bombardier, Claire
AU  - Bombardier C
AD  - Ontario Best Practices Research Initiative, Toronto General Research Institute, 
      University Health Network, Toronto, ON, Canada; Department of Medicine (DOM) and 
      Institute of Health Policy, Management, and Evaluation (IHPME), University of 
      Toronto, Toronto, ON, Canada; Division of Rheumatology, Mount Sinai Hospital, 
      Toronto, ON, Canada. Electronic address: claire.bombardier@utoronto.ca.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200714
PL  - United States
TA  - Semin Arthritis Rheum
JT  - Seminars in arthritis and rheumatism
JID - 1306053
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Tumor Necrosis Factor Inhibitors)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - *Antirheumatic Agents/adverse effects
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Biological Therapy
MH  - Humans
MH  - Registries
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor Inhibitors
MH  - Tumor Necrosis Factor-alpha/therapeutic use
OTO - NOTNLM
OT  - Discontinuation
OT  - Rheumatoid arthritis
OT  - TNF
OT  - Treatment
OT  - bDMARDs
COIS- Declaration of Competing Interest MM, AC are employees at OBRI with no conflict 
      of interest. EH and RM are rheumatology fellows at the University of Ottawa and 
      University of Toronto respectively with no conflict of interest, ML is an 
      associate professor in McMaster university and has no conflict of interest. CB 
      held a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care.
EDAT- 2020/09/11 06:00
MHDA- 2021/09/30 06:00
CRDT- 2020/09/10 20:15
PHST- 2020/02/20 00:00 [received]
PHST- 2020/05/19 00:00 [revised]
PHST- 2020/06/25 00:00 [accepted]
PHST- 2020/09/11 06:00 [pubmed]
PHST- 2021/09/30 06:00 [medline]
PHST- 2020/09/10 20:15 [entrez]
AID - S0049-0172(20)30202-X [pii]
AID - 10.1016/j.semarthrit.2020.06.020 [doi]
PST - ppublish
SO  - Semin Arthritis Rheum. 2020 Oct;50(5):915-922. doi: 
      10.1016/j.semarthrit.2020.06.020. Epub 2020 Jul 14.