Introduction

Biologic treatments including subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) have greatly improved disease management of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA) (collectively inflammatory arthritis, IA). Nevertheless, some patients discontinue their first-line treatment; for them, one option may be a subsequent line of the same treatment class (i.e., cycling). The aim of this study was to assess treatment persistence between first- and second-line therapy in Swedish IA patients cycling on SC-TNFis.

Methods

Using data from the Swedish Health Data Registers, adult IA patients filling prescriptions between May 1, 2010, and October 31, 2016, for a SC-TNFi (adalimumab, etanercept, certolizumab and golimumab) were included. Treatment persistence was derived based on information from filled prescriptions and a 60-day grace period. Unadjusted and adjusted marginal Cox proportional hazards models were fitted to estimate the relative risk of discontinuation across treatment lines, using robust sandwich covariance matrix estimates to account for intrapatient dependence (i.e., multiple treatment lines per patient). The analysis was restricted to the first two lines of treatment.

Results

Of the eligible patients, 3181 were identified as cyclers. Among these, most were female (68%), and 48%, 28% and 24% were diagnosed with RA, AS and PsA, respectively. Both the unadjusted and adjusted analyses showed that the relative risk of discontinuing SC-TNFi treatment was significantly lower in second compared to first line (hazard ratio: 0.56 [0.53, 0.59] and 0.59 [0.56, 0.62], respectively). This finding was also consistent across IA indications.

Conclusions

In this study of patients cycling on SC-TNFis in IA, persistence was greater in second- compared to first-line treatment. The finding was consistent across all IA indications. Hence, patients who discontinue their first-line treatment may still benefit from treatment with an alternative SC-TNFi as a second-line therapy in IA.

中文翻译：

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皮下肿瘤坏死因子-α抑制剂在炎症性关节炎中循环治疗的持久性：一项回顾性研究

介绍

包括皮下肿瘤坏死因子-α抑制剂 (SC-TNFis) 在内的生物治疗极大地改善了类风湿关节炎 (RA)、银屑病关节炎 (PsA) 和脊柱关节炎 (SpA)（统称为炎症性关节炎，IA）的疾病管理。然而，一些患者停止了他们的一线治疗；对他们来说，一种选择可能是同一治疗类别（即骑自行车）的后续路线。本研究的目的是评估瑞典 IA 患者使用 SC-TNFis 进行的一线和二线治疗之间的治疗持久性。

方法

使用瑞典健康数据登记处的数据，纳入 2010 年 5 月 1 日至 2016 年 10 月 31 日期间填写 SC-TNFi（阿达木单抗、依那西普、赛妥珠单抗和戈利木单抗）处方的成年 IA 患者。治疗持久性是根据来自已填写处方的信息和 60 天的宽限期得出的。未调整和调整的边际 Cox 比例风险模型被拟合以估计跨治疗线中止的相对风险，使用稳健的夹心协方差矩阵估计来解释患者内部依赖性（即每位患者多个治疗线）。分析仅限于前两条治疗线。

结果

在符合条件的患者中，3181 名被确定为循环者。其中，大多数为女性（68%），分别有 48%、28% 和 24% 被诊断为 RA、AS 和 PsA。未经调整和调整后的分析均显示，与一线相比，二线中停止 SC-TNFi 治疗的相对风险显着降低（风险比分别为 0.56 [0.53, 0.59] 和 0.59 [0.56, 0.62]）。这一发现在 IA 适应症中也是一致的。

结论

在这项针对 IA 患者循环使用 SC-TNFis 的研究中，与一线治疗相比，二线治疗的持久性更高。这一发现在所有 IA 适应症中都是一致的。因此，停止一线治疗的患者仍可能受益于替代 SC-TNFi 作为 IA 的二线治疗。