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Tumor necrosis factor (TNF) blockers not only lower inflammation but also boost quality of life for patients with inflammatory arthritis, according to one of the largest comparative studies to date involving this class of drugs.
Chen JS, Makovey J, Lassere M, et al. Comparative Effectiveness of Anti–Tumor Necrosis Factor Drugs on Health-Related Quality of Life Among Patients With Inflammatory Arthritis.Arthritis Care & Research. (2014) 66:464–472. DOI: 10.1002/acr.22151. [Epub Feb 24]
Tumor necrosis factor (TNF) blockers not only lower inflammation but also boost health-related quality of life (HRQOL) for patients with rheumatoid arthritis and other types of inflammatory arthritis, according to Australian researchers reporting one of the largest comparative studies to date involving this class of drugs.
Observing that little is known about the comparative effects of these drugs on quality of life in actual clinical practice, the researchers analyzed twice-yearly HRQOL assessments for 3,033 patients with RA, ankylosing spondylitis (AS), and psoriatic arthritis (PsA) who took etanercept, adalimumab, or infliximab between 2001 and 2011. They found the greatest benefits during the initial period of use -- especially in RA.
Overall, the three TNF drugs produced similar benefits for all patients in real-life HRQOL measures, including reduced physical disability, improved function in everyday activities, and psychological well-being.
Most of the patients from the Australian Rheumatology Association Database were white and had RA (n=2,240); 507 had AS and 286 had PsA. The mean disease duration was 15 years. More men (69.2%) than women had AS.
Starting with the onset of TNF therapy, every six months patients filled out the Medical Outcomes Study Short Form 36 (SF-36), Assessment of Quality of Life (AQoL), and Health Assessment Questionnaire (HAQ) disability index (DI) questionnaires.
Over half of those with RA (52%) took etanercept as their initial therapy. RA patients reported that the effects of their medications reduced over time for three measures -- the SF-36 physical component summary, the AQoL, and HAQ DI scores.
Patients who had previously been on one of these drugs had a diminished boost in quality of life after starting another, compared to TNF-naive patients. Infliximab had a slightly greater effect than etanercept on AQoL scores among the PsA patients, and among RA patients adalimumab seemed to have more impact than etanercept on the SF-36 mental component summary score. But none of these differences was clinically significant.
By the time of their last HRQOL assessment, 25% of TNF patients had switched to another drug, and 12% had switched more than once. Those who switched drugs did so mostly due to lack of effectiveness or side effects. Those who stopped TNF therapy said their arthritis had improved or gone into remission.