Rate and causes of infliximab discontinuation in patients with rheumatoid arthritis in a private clinical practice

J Clin Rheumatol. 2008 Dec;14(6):313-7. doi: 10.1097/RHU.0b013e31817a7e0e.

Abstract

Objectives: To describe the rate of infliximab discontinuation and the causes of this event in a population of rheumatoid arthritis patients.

Patients and methods: Rheumatoid arthritis patients from an out-patient private center treated with infliximab (at least 2 consecutive doses) were retrospectively studied. The infliximab discontinuation rate was examined by the Kaplan-Meier survival method. Variables associated with infliximab discontinuation were analyzed by univariable and multivariable Cox proportional hazards regression analyses.

Results: Seventy-seven patients treated with infliximab between August 2000 and December 2006 were identified; of them, 33 (43%) discontinued this drug. The cumulative discontinuation rate was of 23%, 35%, and 43% at 12, 24, and 36 months, respectively. Causes of discontinuation were drug-related adverse reactions (41%), financial constraints (15%), lack of efficacy (12%), and others (32%). Variables independently associated with infliximab discontinuation were the number of tender joints on an average during infliximab treatment [hazard ratio (HR) = 1.17, 95% confidence interval (CI) 1.05-1.31; P = 0.005] and the occurrence of any adverse reaction attributed to infliximab (HR = 2.86, 95% CI 1.37-7.19; P = 0.026), whereas having full pharmacy coverage for infliximab (HR = 0.32, 95% CI 0.13-0.79, P = 0.014) was protective.

Conclusion: Forty-three percent of patients discontinued infliximab at 3 years; most of them because of adverse reactions and financial constraints. Rheumatologists should be aware that those patients with more active disease were also at higher risk of discontinuing infliximab.

MeSH terms

  • Adult
  • Antibodies, Monoclonal* / adverse effects
  • Antibodies, Monoclonal* / economics
  • Antirheumatic Agents* / adverse effects
  • Antirheumatic Agents* / economics
  • Argentina
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / economics
  • Clinical Medicine / statistics & numerical data*
  • Contraindications
  • Female
  • Health Care Costs
  • Humans
  • Infliximab
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Regression Analysis
  • Retrospective Studies
  • Treatment Outcome
  • Treatment Refusal / statistics & numerical data*

Substances

  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Infliximab