NEW YORK (Reuters Health) Oct 13 - The results of the Brigham Rheumatoid Arthritis Sequential Study (BRASS) show that 42% of rheumatoid arthritis (RA) patients discontinue treatment with tumor necrosis factor-alpha (TNF) inhibitors within roughly 3 years.

Treatment adherence patterns for 503 RA patients in the multicenter BRASS on either etanercept, infliximab or adalimumab for at least 6 months (mean follow-up, 39 months) are reported in the September issue of the Journal of Rheumatology by Dr. Sandeep K. Agarwal of the University of Texas Health Science Center in Houston and colleagues.

Out of the 503 patients, 210 patients (42%) reported discontinuation of TNF inhibitor treatment.

Predictors of discontinuation were higher physician global scores, with a hazard ratio of 1.27, and higher RA Disease Activity Index scores, with a hazard ratio of 1.13, six months prior to stopping the drug.

Predictors that the patient would continue with prescribed TNF inhibitor therapy were a prior history of treatment with a synthetic disease modifying RA drug (DMARD), which had a hazard ratio of 0.50. Multiple years of methotrexate use was another predictor that TNF inhibitor treatment would continue, with a hazard ratio of 0.24.

Dr. Agarwal and colleagues note that RA patients who discontinue TNF inhibitor therapy "will require subsequent disease modifying antirheumatic therapy, which is likely to include biologic response modifiers. The ability to predict which patients will respond to specific targeted therapies will be extremely useful in the management of RA."

"Extending our understanding of the biologic mechanisms of the disease and the social influences underlying discontinuation of TNF inhibitors is essential so that we can develop clinical models to predict which antirheumatic therapeutic regimen will be of greatest benefit to patients with RA," Dr. Agarwal and associates write.

J Rheumatol 2008;35:1737-1744.