Patients with rheumatoid arthritis treated with etanercept were more likely to remain on this therapy at 12 months compared with other tumor necrosis factor inhibitors (TNFi), according to research published in The Journal of Rheumatology.

Researchers conducted a systematic literature review and meta-analysis to evaluate long-term drug survival and discontinuation of etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab in patients with rheumatoid arthritis. In total, 170 publications were included (133 full articles and 37 conference abstracts). A majority of publications were rated as “excellent” or “good” quality. Patient populations ranged from 18 to 17,405 patients, with mean or median follow-up periods ranging from 12 months to 12 years. Most studies included more women than men (70% to 90% women) with a mean or median age from 50 to 60 years. At baseline, mean or median disease duration ranged from 2.4 to 18.5 years. Drug survival end points were estimated using data from 109 publications.

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In a first-line treatment setting, TNFi survival rates at 12 months ranged from 62% to 71% and 57% to 72% at 12 to 24 months. Second-line treatment survival rates ranged from 55% to 69% and 38% to 57% at 12 and 12 to 24 months, respectively. Investigators pooled data for an exploratory meta-analysis of TNFi survival at ≥36 months; due to a lack of data, drug survival for certolizumab pegol and golimumab were not calculated. The etanercept group had the highest rate of drug survival in the first-line treatment setting (59%; 95% CI, 46%-72%); this was followed by adalimumab and infliximab (51% [95% CI, 41%-60%] and 49% [95% CI, 43%-54%], respectively). Etanercept also had the highest rate of drug survival in the second-line treatment setting (56%; 95% CI, 52%-61%). At 48 months, drug survival in the first-line setting with etanercept ranged from 23% to 69%, with adalimumab from 27% to 54%, and with infliximab from 18% to 79%. At each time point evaluated, etanercept had the highest survival rate. In total, 134 publications reported data on treatment discontinuation. At 36 months, infliximab treatment had the highest rate of total discontinuations (42%-62%); adalimumab (38%-59%), etanercept (38%-48%), and golimumab (35%) followed. In terms of adverse event–related discontinuations, patients on etanercept therapy had a lower rate of discontinuation (8% to 16%) compared with those receiving adalimumab (8%-26%) or infliximab (15%-27%).

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Study limitations include the observational nature of the study, the possibility that patients may have been double counted due to identical or similar data in multiple publications, and the limited data available for certolizumab pegol or golimumab for some variables.

“Evidence-based insight into the drug survival and discontinuation rates associated with each specific TNFi agent is key when evaluating the real-world effectiveness and cost-effectiveness of these agents,” researchers concluded. “[D]ata on drug survival can help inform decision-making aimed at achieving optimal disease outcomes while limiting costs.”

This review was funded by Pfizer. Multiple researchers report relationships with the pharmaceutical industry. For a complete list of disclosures, please see the full text of the study online.


Emery P, Vlahos B, Szczypa P, et al. Long-term drug survival of tumor necrosis factor inhibitors in patients with rheumatoid arthritis [published online June 1, 2019]. J Rheumatol. doi: 10.3899/jrheum.181398