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The effect of comedication with conventional synthetic disease modifying antirheumatic drugs on TNF inhibitor drug survival in patients with ankylosing spondylitis and undifferentiated spondyloarthritis: results from a nationwide prospective study

Artikel i vetenskaplig tidskrift
Författare Elisabeth Lie
Lars Erik Kristensen
Helena Forsblad d'Elia
Tatiana Zverkova Sandström
J. Askling
Lennart T. H. Jacobsson
Publicerad i Annals of the Rheumatic Diseases
Volym 74
Nummer/häfte 6
Sidor 970-978
ISSN 0003-4967
Publiceringsår 2015
Publicerad vid Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 970-978
Språk en
Länkar dx.doi.org/10.1136/annrheumdis-2014...
Ämnesord Ankylosing Spondylitis, Spondyloarthritis, Anti-TNF, DMARDs (synthetic), SOCIETY CLASSIFICATION CRITERIA, TREATMENT GROUP REGISTER, NECROSIS, FACTOR THERAPY, PSORIATIC-ARTHRITIS, INFLAMMATORY DISEASES, RHEUMATOID-ARTHRITIS, TREATMENT RESPONSE, ANTIBODY-FORMATION, DANBIO, REGISTRY, INFLIXIMAB, Rheumatology
Ämneskategorier Reumatologi och inflammation

Sammanfattning

Objective To assess the effect of comedication with conventional synthetic disease modifying antirheumatic drugs (csDMARDs) on retention to tumour necrosis factor inhibitor (TNFi) therapy in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA). Methods Data on patients with a clinical diagnosis of AS or uSpA starting treatment with adalimumab, etanercept or infliximab as their first TNFi during 2003-2010 were retrieved from the Swedish national biologics register and linked to national population based registers. Five-year drug survival was analysed by Cox regression with age, sex, baseline csDMARD comedication, TNFi type, prescription year and covariates representing frailty and socioeconomic status. AS and uSpA were analysed separately. Sensitivity analyses included models with csDMARD as a time-dependent covariate and adjustments for additional potential confounders. Results 1365 patients with AS and 1155 patients with uSpA were included, of whom 40.8% versus 50.3% used csDMARD comedication at baseline. In the unadjusted analyses superior drug survival was observed for patients using versus not using csDMARD comedication among patients with AS (p<0.001) but not among patients with uSpA (p=0.175). In the multivariable Cox regression analyses comedication with csDMARD was associated with better retention to TNFi therapy both in AS (HR 0.71, p<0.001) and uSpA (HR 0.82, p=0.020). The results were similar with csDMARD comedication as a time-dependent covariate, and the associations were retained when adjusting for erythrocyte sedimentation rate, C-reactive protein, patient global, swollen joints, uveitis, psoriasis and inflammatory bowel disease. Conclusions In this large register study of patients with AS and uSpA, use of csDMARD comedication was associated with better 5-year retention to the first TNFi.

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