Life table analysis of 879 treatment episodes with slow acting antirheumatic drugs in community rheumatology practice

ArticleinThe Journal of Rheumatology 19(5):704-8 · June 1992with7 Reads
Source: PubMed
Abstract
In 596 patients with RA managed over a decade in a community practice setting, 879 slow acting antirheumatic drug (SAARD) treatment episodes were analyzed using 5-year life tables. The probability of continuation of therapy was 50% by 9-24 months for all drugs except for methotrexate (MTX), which was 62% by 5 years [corrected]. MTX treatments were of significantly longer duration than those of all other SAARD (p less than 0.001); terminations for both inefficacy (p less than 0.001) and toxicity (NS) were less likely. These findings concur with recent evidence suggesting that MTX is a superior SAARD in this setting.
    • "Hence, folate supplementation is increasingly becoming considered a standard part of therapy for patients on MTX. Adverse effects of MTX include stomatitis, nausea, diarrhea, and alopecia, all of which may decrease with concomitant folic acid or folinic acid130131132. Other side effects of MTX therapy include leukopenia, bone marrow suppression (both usually reversible on stopping the drug), pulmonary symptoms, including MTX pneumonitis and pulmonary fibrosis, and rarely liver fibrosis and cirrhosis. "
    [Show abstract] [Hide abstract] ABSTRACT: Osteoarthritis (OA) is a slowly evolving but active disease of degeneration of the articular cartilage associated with symptoms of joint pain, stiffness, and limitation of movement. Typically, these symptoms tend to be worse with weight bearing and activity and improve with rest. Physical examination often reveals tenderness on palpation, bony enlargement, crepitus on movements, and limitation of joint movement. OA can occur in any joint but is most common in the hip, knee, and the joints of the hand, foot, and spine. OA is the most prevalent disease in our society and the second most common cause of disability in the elderly in the Western world, second only to cardiovascular disease [1]. In fact, more than 75% of persons above 70 years of age show some radiographic evidence of OA [2]. The World Health Organization (WHO) figures of worldwide estimates are that 9.6% of men and 18% of women aged more than 60 years have symptomatic OA [3]. The prevalence of OA increases with age because the condition is not reversible. Men are affected more often than women among those aged less than 45 years, whereas women are affected more frequently among those aged more than 55 years [4]. The prevalence of OA is only likely to rise further, due to a variety of reasons. Life expectancy has steadily increased over the years and continues to do so. The triad of increasing numbers of elderly people, obesity, and lack of exercise plaguing Western society at the moment is likely to have a significant effect on the burden of OA facing people and society in the next few decades.
    Full-text · Chapter · Mar 2008 · Rheumatology
    • "Of further interest, Measuring the effectiveness of drugs through observational databases has some limitations, such as assignment of treatment , patient selection bias, and the absence of a washout period [19] . Nonetheless, drug survival can be taken as a sensible indicator of its effectiveness in the clinical setting, and community-based studies that analyze continuation of treatment with different DMARDs are common in rheumatology202122232425 . Furthermore, withdrawal rates of DMARDs in observational studies are similar to those reported in clinical trials [25] . "
    [Show abstract] [Hide abstract] ABSTRACT: The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications.
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    • "When administered in low weekly doses, methotrexate is effective and its toxicity can be managed effectively. Moreover, patient retention on methotrexate (62% by 5 yr) tends to be longer than with other DMARDs [17]. Many early studies were largely unsuccessful in showing the superiority of combination DMARD therapy over single-agent therapy181920. "
    [Show abstract] [Hide abstract] ABSTRACT: The past decade has seen a shift in the paradigm for RA management. DMARDs have been introduced at earlier stages of disease in an effort to slow or stop radiographic disease progression before irreversible joint damage, work disability, functional decline and other adverse outcomes are seen. Although often effective, DMARDs have been limited in treatment durability over the long term due to side-effects and declining efficacy. Combination regimens, often involving weekly methotrexate as the anchor drug, have been used increasingly to overcome the limitations of DMARD monotherapy. The advent of biological therapies that specifically target key proinflammatory cytokines, believed to be important in disease pathogenesis, provides several new treatment options. In controlled clinical trials, the IL-1 blocker anakinra (r-metHuIL-1ra) significantly reduced the clinical signs and symptoms of RA when used alone or in combination with weekly methotrexate. The TNF inhibitors etanercept, infliximab and adalimumab have shown similar efficacy; indeed, higher response rates for clinical and radiological parameters have been seen with the TNF blockers. Importantly, each of these biological response modifiers significantly reduced radiographic disease progression in 6- to 12-month studies, and some radiographic data extend to 24 months. Despite these promising findings, it remains to be determined whether slowing radiographic progression will translate into significant improvements in long-term outcomes.
    Full-text · Article · Jul 2004
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