Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry

Sofie H.M. Manders; Wietske Kievit; Tim L.T.A. Jansen; Jan N. Stolk; Henk Visser; Annemarie M. Schilder; Harald E. Vonkeman; Eddy Adang; Mart A.F.J. van de Laar; Piet L.C.M. van Riel

doi:10.3899/jrheum.151014

Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry

Sofie H.M. Manders^*, Wietske Kievit, Tim L.T.A. Jansen, Jan N. Stolk, Henk Visser, Annemarie M. Schilder, Harald E. Vonkeman, Eddy Adang, Mart A.F.J. van de Laar, Piet L.C.M. van Riel

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

15 Citations (Scopus)

Abstract

Objective. To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice.

Methods. Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders.

Results. The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value.

Conclusion. Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.

Original language	English
Pages (from-to)	1787-1794
Number of pages	8
Journal	Journal of rheumatology
Volume	43
Issue number	10
DOIs	https://doi.org/10.3899/jrheum.151014
Publication status	Published - Oct 2016
Externally published	Yes

Keywords

Disease-Modifying Antirheumatic Drugs
Methotrexate
Rheumatoid Arthritis
Tumor Necrosis Factor Inhibitor

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3899/jrheum.151014

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Manders, S. H. M., Kievit, W., Jansen, T. L. T. A., Stolk, J. N., Visser, H., Schilder, A. M., Vonkeman, H. E., Adang, E., van de Laar, M. A. F. J., & van Riel, P. L. C. M. (2016). Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry. Journal of rheumatology, 43(10), 1787-1794. https://doi.org/10.3899/jrheum.151014

@article{f8c7e989cb40489ca2908f1537f32730,

title = "Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry",

abstract = "Objective. To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice.Methods. Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders.Results. The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value.Conclusion. Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.",

keywords = "Disease-Modifying Antirheumatic Drugs, Methotrexate, Rheumatoid Arthritis, Tumor Necrosis Factor Inhibitor",

author = "Manders, {Sofie H.M.} and Wietske Kievit and Jansen, {Tim L.T.A.} and Stolk, {Jan N.} and Henk Visser and Schilder, {Annemarie M.} and Vonkeman, {Harald E.} and Eddy Adang and {van de Laar}, {Mart A.F.J.} and {van Riel}, {Piet L.C.M.}",

year = "2016",

month = oct,

doi = "10.3899/jrheum.151014",

language = "English",

volume = "43",

pages = "1787--1794",

journal = "Journal of rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology",

number = "10",

}

Manders, SHM, Kievit, W, Jansen, TLTA, Stolk, JN, Visser, H, Schilder, AM, Vonkeman, HE, Adang, E, van de Laar, MAFJ & van Riel, PLCM 2016, 'Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry', Journal of rheumatology, vol. 43, no. 10, pp. 1787-1794. https://doi.org/10.3899/jrheum.151014

Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry. / Manders, Sofie H.M.; Kievit, Wietske; Jansen, Tim L.T.A. et al.
In: Journal of rheumatology, Vol. 43, No. 10, 10.2016, p. 1787-1794.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis

T2 - Data from the DREAM registry

AU - Manders, Sofie H.M.

AU - Kievit, Wietske

AU - Jansen, Tim L.T.A.

AU - Stolk, Jan N.

AU - Visser, Henk

AU - Schilder, Annemarie M.

AU - Vonkeman, Harald E.

AU - Adang, Eddy

AU - van de Laar, Mart A.F.J.

AU - van Riel, Piet L.C.M.

PY - 2016/10

Y1 - 2016/10

N2 - Objective. To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice.Methods. Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders.Results. The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value.Conclusion. Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.

AB - Objective. To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice.Methods. Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders.Results. The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value.Conclusion. Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD.

KW - Disease-Modifying Antirheumatic Drugs

KW - Methotrexate

KW - Rheumatoid Arthritis

KW - Tumor Necrosis Factor Inhibitor

UR - http://www.scopus.com/inward/record.url?scp=84989919205&partnerID=8YFLogxK

U2 - 10.3899/jrheum.151014

DO - 10.3899/jrheum.151014

M3 - Article

C2 - 27481900

AN - SCOPUS:84989919205

SN - 0315-162X

VL - 43

SP - 1787

EP - 1794

JO - Journal of rheumatology

JF - Journal of rheumatology

IS - 10

ER -

Effectiveness of tumor necrosis factor inhibitors in combination with various csDMARD in the treatment of rheumatoid arthritis: Data from the DREAM registry

Abstract

Keywords

UN SDGs

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