Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register. Kristensen, L. E., Karlsson, J. A., Englund, M., Petersson, I. F., Saxne, T., & Geborek, P. 62(10):1362--1369.
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OBJECTIVE: To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice. METHODS: Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years. RESULTS: The 2-year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19-0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27-0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25-1.04], P = 0.062), whereas no differences were found comparing the 3 anti-tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level (HR 0.99 [95% CI 0.97-1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34-1.10], P = 0.10) also showed trends to entail better drug adherence. CONCLUSION: AS patients in this study have an excellent 2-year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.
@article{kristensen_presence_2010,
	title = {Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register},
	volume = {62},
	issn = {2151-4658},
	doi = {10.1002/acr.20258},
	shorttitle = {Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis},
	abstract = {{OBJECTIVE}: To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis ({AS}) patients who had never taken biologics treated in clinical practice.
{METHODS}: Patients in southern Sweden with active {AS} starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75\% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug ({DMARD}) treatment course. The mean ± {SD} age at inclusion was 43 ± 12 years, with a mean ± {SD} disease duration prior to treatment of 16 ± 12 years.
{RESULTS}: The 2-year drug continuation rate was 74\%. Male sex (hazard ratio [{HR}] of premature discontinuation 0.36 [95\% confidence interval (95\% {CI}) 0.19-0.68]) and the presence of peripheral arthritis ({HR} 0.49 [95\% {CI} 0.27-0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab ({HR} 0.50 [95\% {CI} 0.25-1.04], P = 0.062), whereas no differences were found comparing the 3 anti-tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level ({HR} 0.99 [95\% {CI} 0.97-1.00], P = 0.12) and concomitant treatment with nonbiologic {DMARDs} ({HR} 0.61 [95\% {CI} 0.34-1.10], P = 0.10) also showed trends to entail better drug adherence.
{CONCLUSION}: {AS} patients in this study have an excellent 2-year drug survival rate of 74\%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.},
	pages = {1362--1369},
	number = {10},
	journaltitle = {Arthritis Care \& Research},
	shortjournal = {Arthritis Care Res (Hoboken)},
	author = {Kristensen, L. E. and Karlsson, J. A. and Englund, M. and Petersson, I. F. and Saxne, T. and Geborek, P.},
	date = {2010-10},
	pmid = {20506310},
	keywords = {Adalimumab, Adult, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Cohort Studies, Etanercept, Female, Follow-Up Studies, Humans, Immunoglobulin G, Infliximab, Male, Middle Aged, Osteoarthritis, Predictive Value of Tests, Prospective Studies, Receptors, Tumor Necrosis Factor, Registries, Sex Factors, Spondylitis, Ankylosing, Sweden, Treatment Outcome, Tumor Necrosis Factor-alpha}
}
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