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Survival of disease-modifying antirheumatic drugs used as the first antirheumatic medication in the treatment of ankylosing spondylitis in Finland. A nationwide population-based register study

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Abstract

The tight national drug reimbursement regulations in the treatment of ankylosing spondylitis (AS) in Finland lead to the practice that at least one traditional disease-modifying antirheumatic drug (DMARD), if not contraindicated, has been tried and has failed before a patient can be eligible for reimbursement of anti-tumour necrosis factor (TNF) treatment. The aim of the present study is to evaluate drug survival of the firstly prescribed DMARDs in patients with AS. All AS patients from January 1, 2000 to December 31, 2007 were collected from the nationwide drug reimbursement registry maintained by the Social Insurance Institution (SII). Data on antirheumatic medication came from the prescription registry of SII. A total of 2,890 AS patients (60 % males) were identified. Sulfasalazine (SSA) monotherapy was the most common first antirheumatic treatment (2,319 patients, 87 %), followed by methotrexate (MTX) monotherapy (230 patients, 9 %) and by hydroxychloroquine monotherapy (77 patients, 3 %). A combination of two or more DMARDs was used by 44 patients (2 %). Only seven patients (0.3 %) had biological (etanercept or adalimumab) started as the first antirheumatic drug. Median survival time of SSA monotherapy was 4.5 years (95 % CI 4.2 to 4.8) and that of MTX was 1.9 years (95 % CI 1.5 to 2.1). SSA is almost the standard as the first antirheumatic treatment of AS in Finland. Although the clinical efficiency of SSA was not evaluable in the present study, these data suggest that the use of SSA can at least postpone the need and start of TNF inhibitors with marked economic consequences.

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Acknowledgments

The study was supported by the Helsinki University Central Hospital Research Funds and by a grant of the Finska Läkaresällskapet and Reumatautien tutkimussäätiö. We thank Dr. Kalle Aaltonen for providing data from the ROB-FIN register.

Disclosures

Heikki Relas, Hannu Kautiainen, and Lauri Virta: none.

Kari Puolakka: personal fees from Pfizer, MSD, UCB, Abbvie, Roche, BMS.

Marjatta Leirisalo-Repo: consultant for Pfizer, MSD, GSK, Schering-Plough, Abbvie, Roche. Personal fees from Roche, MSD, Abbvie, Pfizer, BMS, UCB, Pharma Industry Finland. Investigator in clinical drug trials sponsored by Roche, Centocor, Wyeth/Pfizer, Merck, Serono, Celtic, BMS, Celgene, MSD, Sanofi.

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Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, PO BOX 372, FI-00029 HUS, Helsinki, Finland

    Heikki Relas & Marjatta Leirisalo-Repo

  2. Unit of Family Practice, Central Finland Central Hospital, Jyväskylä, Finland

    Hannu Kautiainen

  3. Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland

    Hannu Kautiainen

  4. Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland

    Kari Puolakka

  5. Research Department, Social Insurance Institution, Turku, Finland

    Lauri J. Virta

  6. Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland

    Marjatta Leirisalo-Repo

Authors
  1. Heikki Relas
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  2. Hannu Kautiainen
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  3. Kari Puolakka
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  4. Lauri J. Virta
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  5. Marjatta Leirisalo-Repo
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Correspondence to Heikki Relas.

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Relas, H., Kautiainen, H., Puolakka, K. et al. Survival of disease-modifying antirheumatic drugs used as the first antirheumatic medication in the treatment of ankylosing spondylitis in Finland. A nationwide population-based register study. Clin Rheumatol 33, 1135–1138 (2014). https://doi.org/10.1007/s10067-014-2700-5

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  • DOI: https://doi.org/10.1007/s10067-014-2700-5

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