A significant percentage of patients receiving anti-tumor necrosis factor alpha (anti-TNFα)
agents lose clinical response over time. This study aims to provide representative
real-world data on anti-TNFα drug sustainability, prevalence and predictors of anti-TNFα
dose escalation.In this nationwide, retrospective study, patients receiving infliximab
or adalimumab therapy between 2013 and 2016 were included using the administrative
claims database of the Hungarian National Health Insurance Fund. Demographic characteristics,
drug sustainability, dose escalation, use of parallel medications were analyzed.476
infliximab and 397 adalimumab patients were included. Dose escalation was observed
in 7%, 9% and 22% of patients receiving originator/biosimilar infliximab and adalimumab
during the complete follow-up, respectively. Dose escalation was associated with shorter
disease duration (OR = 1.75, p = 0.026) and corticosteroid use. Drug retention rates
were 62.7%, 72.3%, 75.4% after 1 year follow-up for Remicade®, Inflectra® and Humira®,
which decreased to 38.3% and 52.1% for Remicade® and Humira® at 3 years. Drug sustainability
was affected by steroid use prior biologic initiation in adalimumab treated patients
(HR = 2.04, p < 0.001), while in infliximab treated patients dose escalation (HR =
0.51, p = 0.02) and gender (HR = 1.39, p = 0.033) were predictors of treatment discontinuation.Dose
escalation rates were lower in this real-world administrative database study for both
adalimumab and infliximab compared to published data. Drug retention rates were overall
satisfactory, with no apparent difference between the legacy and biosimilar infliximab.
