Treatment Patterns Following Discontinuation of Adalimumab, Etanercept, and Infliximab in a US Managed Care Sample
Because clinical guidelines do not offer clear recommendations for treatment options after discontinuing a tumor necrosis factor (TNF) blocker, this study evaluated treatment patterns within 360 days after discontinuation of TNF-blocker treatment.
The IMS LifeLink Health Plan Claims database was used to identify patients diagnosed with rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received etanercept, adalimumab, or infliximab between January 1, 2005 and March 31, 2009. Discontinuation from index (first) TNF blocker was defined as switching to a different TNF blocker or a >45-day gap in therapy. Patients were categorized into mutually exclusive groups in descending order: (a) restart of index TNF blocker; (b) switch to another TNF blocker; (c) switch to a different biologic; (d) switch to nonbiologic therapy; or (e) no new treatment.
Among 27,704 patients who initiated TNF-blocker therapy, 14,707 (53%) patients discontinued treatment over 1–3 years of follow-up. Within 360 days of discontinuing index TNF blocker, 53.4% of patients restarted index therapy: etanercept 59.9%, adalimumab 46.5%, and infliximab 43.1% (P < 0.001 for etanercept vs. adalimumab and infliximab). The majority of therapy restarts occurred within the first 3 months after discontinuation. Other patients switched to another TNF blocker: etanercept 17.1%, adalimumab 19.1% (P = 0.010 vs. etanercept), and infliximab 15.0% (P = 0.009 vs. etanercept). Switches from index TNF blocker to non-TNF-blocker biologic therapy were low: etanercept 1.9%, adalimumab 4.1%, and infliximab 10.7% (P < 0.001 for etanercept vs. adalimumab and infliximab). Switches from index TNF blocker to nonbiologic treatments were 5.4% for etanercept, 6.5% for adalimumab, and 6.9% for infliximab.
Restarting of index TNF-blocker therapy occurs frequently after discontinuation, suggesting that long gaps in TNF-blocker therapy may be common. A significantly higher proportion of etanercept patients restarted their index TNF blocker within 3 months of discontinuation, compared with adalimumab and infliximab patients.
KeywordsAdalimumab Ankylosing spondylitis Dermatology Etanercept Infliximab Psoriasis Psoriatic arthritis Rheumatology Rheumatoid arthritis Tumor necrosis factor blocker
Sponsorship and article processing charges for this study was funded by Immunex, a wholly owned subsidiary of Amgen Inc. (California, USA). Medical writing assistance for this study was provided by Edward Mancini of Amgen Inc. and Julia R. Gage of Gage Medical Writing, LLC. This was funded by Amgen Inc. (California, USA). All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval of the version to be published.
Conflict of interest
S.R. Gandra is an employee and shareholder of Amgen Inc.
C. Watson is a former employee and shareholder of Amgen Inc.
K. Fox is an employee of Strategic Healthcare Solutions, LLC, which received funding for the study from Amgen Inc.
V. Schabert is an employee of IMS Health, which received funding for the study from Amgen Inc.
J. Yeaw is an employee of IMS Health, which received funding for the study from Amgen Inc.
S. Goodman is an employee of IMS Health, which received funding for the study from Amgen Inc.
Compliance with ethics guidelines
The analysis in this article is based on data obtained from patient records in a commercial claims database and no human or animal subjects were used in the study.
- 1.Bathon J. Anti-TNF therapy for the treatment of rheumatoid arthritis. Johns Hopkins Arthritis Center, Baltimore, MD. 2011. http://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/. Date Accessed 22 Aug 2013.
- 3.Enbrel® (etanercept) Prescribing Information, Immunex Corporation, Thousand Oaks, CA. 2013.Google Scholar
- 4.Humira® (adalimumab) Prescribing Information, Abbott Laboratories, Abbott Park, IL. 2013.Google Scholar
- 5.Remicade® (infliximab) Prescribing Information, Centocor, Inc., Malvern, PA. 2013.Google Scholar
- 6.Hetland ML, Christensen IJ, Tarp U, et al. Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry. Arthritis Rheum. 2010;62:22–32.PubMedCrossRefGoogle Scholar
- 8.Kristensen LE, Saxne T, Nilsson JA, Geborek P. Impact of concomitant DMARD therapy on adherence to treatment with etanercept and infliximab in rheumatoid arthritis. Results from a six-year observational study in southern Sweden. Arthritis Res Ther. 2006;8:R174.PubMedCentralPubMedCrossRefGoogle Scholar
- 10.Heiberg MS, Koldingsnes W, Mikkelsen K, et al. The comparative one-year performance of anti-tumor necrosis factor alpha drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Rheum. 2008;59:234–40.PubMedCrossRefGoogle Scholar
- 14.Saad AA, Ashcroft DM, Watson KD, Hyrich KL, Noyce PR, Symmons DP. Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register. Arthritis Res Ther. 2009;11:R52.PubMedCentralPubMedCrossRefGoogle Scholar
- 18.Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis. National Institute for Health and Care Excellence, London. 2007. http://www.nice.org.uk/TA130. Accessed 23 Aug 2013.
- 22.Hyrich KL, Lunt M, Watson KD, Symmons DP, Silman AJ. British Society for Rheumatology Biologics Register. Outcomes after switching from one anti-tumor necrosis factor alpha agent to a second anti-tumor necrosis factor alpha agent in patients with rheumatoid arthritis: results from a large UK national cohort study. Arthritis Rheum. 2007;56:13–20.PubMedCrossRefGoogle Scholar