Retention on anti-tumour necrosis factor therapy: the Waikato experience

To investigate the retention on anti-TNF agents used in a real-world setting, and determine the factors predicting retention on drug.

Patients starting anti-TNF therapy were recorded prospectively on the departmental database. Medical records of all patients commenced on anti-TNF therapy between 2006 and 2013 at the Rheumatology Department, Waikato Hospital, Hamilton, were retrospectively reviewed to obtain details of their course on biologic therapy.

183 patients were identified. 139 (76.5%) were commenced on adalimumab. The predominant indication was rheumatoid arthritis (52.5%). 60 patients (32.8%) discontinued their initial anti-TNF agent. Of these, 31.7% were due to primary failure, 36.7% due to secondary failure and 25% due to adverse events. At 5 years, retention on agents was: adalimumab (77.2%), etanercept (69.6%) and infliximab (16.7%). Retention on adalimumab was significantly higher than infliximab (p<0.001), but did not differ between adalimumab and etanercept, or etanercept and infliximab.

In a real-world setting, retention on infliximab was significantly lower than adalimumab.