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Factors associated with drug survival on first biologic therapy in patients with rheumatoid arthritis: a population-based cohort study

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Abstract

Lack of sufficient head-to-head trials comparing biologic disease-modifying antirheumatic drugs (bDMARDs) in rheumatoid arthritis (RA), makes the choice of the first bDMARD a matter of rheumatologist’s preference. Longer drug survival on the first bDMARD usually correlates with early remission. We aimed to identify factors associated with longer drug survival. We conducted a population-based retrospective longitudinal cohort study. We identified RA patients using the relevant International Classification of Disease 9th codes. “True” RA patients were defined as patients fulfilling, additionally, at least one of the following: receiving conventional DMARDs (cDMARDs), being positive for rheumatoid factor or anti-cyclic citrullinated peptide, or being diagnosed by a rheumatologist. We compared drug survival times and identified factors associated with longer drug survival. We identified 4268 true RA patients between the years of 2000–2017. 820 patients (19.2%) received at least one bDMARD. The most commonly prescribed bDMARDs were etanercept (352, 42.9%), adalimumab (143, 17.4%), infliximab (142, 17.3%) and tocilizumab (58, 7.1%). Infliximab was associated with the longest drug survival (47.1 months ± 46.3) while golimumab was associated with the shortest drug survival (14.9 months ± 15.1). Male gender [hazard ratio (HR) = 0.76, 95% confidence interval (CI), 0.63–0.86, p = 0.001], concurrent conventional DMARDs use (HR = 0.79, 95% CI 0.68 – 0.98, p = .031) and initiating bDMARD therapy in earlier calendric years (HR = 1.12, 95% CI 1.10 –1.18, p = 0.0001) were associated with longer drug survival. Male gender, concomitant cDMARDs and initiating biologic therapy at earlier calendric years are associated with longer drug survival.

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Availability of data and material

Data were obtained from the Leumit Health Services. The datasets generated during and/or analysed during the current study are not publicly available due to the Leumit Health Services policy.

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Acknowledgements

Thanks to Naama Hayman Brisk for her help in retrieving and processing the data.

Funding

The authors did not receive any funding.

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Author notes

  1. Mohammad E. Naffaa and Fadi Hassan equally contributed to this work.

Authors and Affiliations

  1. Rheumatology Unit, Galilee Medical Center, Road 89, Naharyia, Israel

    Mohammad E. Naffaa & Ziv Paz

  2. Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel

    Mohammad E. Naffaa, Fadi Hassan, Amir Saab & Ziv Paz

  3. Internal Medicine “E”, Galilee Medical Center, Naharyia, Israel

    Fadi Hassan & Amir Saab

  4. Leumit Health Services, Tel Aviv-Yafo, Israel

    Avivit Golan-Cohen, Eugene Merzon & Ilan Green

  5. Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Avivit Golan-Cohen & Ilan Green

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  1. Mohammad E. Naffaa
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  3. Avivit Golan-Cohen
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Correspondence to Mohammad E. Naffaa.

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Ethical approval for this study was obtained from the Galilee Medical Center.

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Naffaa, M.E., Hassan, F., Golan-Cohen, A. et al. Factors associated with drug survival on first biologic therapy in patients with rheumatoid arthritis: a population-based cohort study. Rheumatol Int 41, 1905–1913 (2021). https://doi.org/10.1007/s00296-021-04989-y

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  • DOI: https://doi.org/10.1007/s00296-021-04989-y

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