Longterm Drug Survival of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis

Objective.To evaluate longterm drug survival (proportion of patients still receiving treatment) and discontinuation of etanercept (ETN), infliximab (IFX), adalimumab (ADA), certolizumab pegol (CZP), and golimumab (GOL) using observational data from patients with rheumatoid arthritis (RA).Methods.Following a systematic literature review, drug survival at 12 and 12–24 months of followup was estimated by summing proportions of patients continuing treatment and dividing by number of studies. Drug survival at ≥ 36 months of followup was estimated through Metaprop.Results.There were 170 publications included. In the first-line setting, drug survival at 12 months with ETN, IFX, or ADA was 71%, 69%, and 70%, respectively, while at 12–24 months the corresponding rates were 63%, 57%, and 59%. In the second-line setting, drug survival at 12 months with ETN, IFX, or ADA was 61%, 69%, and 55%, respectively, while at 12–24 months the corresponding rates were 53%, 39%, and 43%. Drug survival at ≥ 36 months with ETN, IFX, or ADA in the first-line setting was 59% (95% CI 46–72%), 49% (95% CI 43–54%), and 51% (95% CI 41–60%), respectively, while in the second-line setting the corresponding rates were 56% (95% CI 52–61%), 48% (95% CI 40–55%), and 41% (95% CI 36–47%). Discontinuation of ETN, IFX, and ADA at 36 months of followup was 38–48%, 42–62%, and 38–59%, respectively. Data on CZP and GOL were scarce.Conclusion.After > 12 months of followup, more patients with RA receiving ETN remain on treatment compared with other tumor necrosis factor inhibitors.