Long-term drug survival of tumor necrosis factor inhibitors in patients with rheumatoid arthritis.

OBJECTIVE: Evaluate long-term drug survival (proportion of patients still receiving treatment) and discontinuation of etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab using observational data from patients with rheumatoid arthritis. METHODS: Following a systematic literature review, drug survival at 12 and 12-24 months of follow-up was estimated by summing proportions of patients remaining on treatment and dividing by number of studies. Drug survival at ≥36 months of follow-up was estimated via Metaprop. RESULTS: 170 publications were included. In the first-line setting, drug survival at 12 months with etanercept, infliximab, or adalimumab was 71%, 69%, and 70%, respectively, while at 12-24 months the corresponding rates were 63%, 57%, and 59%. In the second-line setting, drug survival at 12 months with etanercept, infliximab, or adalimumab was 61%, 69%, and 55%, respectively, while at 12-24 months the corresponding rates were 53%, 39%, and 43%. Drug survival at ≥36 months with etanercept, infliximab, or adalimumab in the first-line setting was 59% (95% confidence interval [CI]: 46-72%), 49% (95% CI: 43-54%), and 51% (95% CI: 41-60%), respectively, while in the second-line setting the corresponding rates were 56% (95% CI: 52-61%), 48% (95% CI: 40-55%), and 41% (95% CI: 36-47%). Discontinuation of etanercept, infliximab, and adalimumab at 36 months of follow-up was 38-48%, 42- 62%, and 38-59%, respectively. Data on certolizumab pegol and golimumab were scarce. CONCLUSION: After >12 months of follow-up, more patients with rheumatoid arthritis receiving etanercept remain on treatment compared with other TNFi.