Objective. The present systematic review of RA registry data was undertaken to analyse the time on treatment of licensed TNF inhibitors in patients with RA in Europe. Methods. English language European registry studies comparing TNF inhibitors were searched using MEDLINE, Embase, Cochrane, and WHO: ICTRP up to 16 April 2012 and proceedings of three selected conferences held between 2010 and 2012. Pooled analysis was performed to determine drug survival rates for each TNF inhibitor. Results. Sixteen studies met the inclusion criteria, of which 11 studies assessed biologic-naive patients and five studies included a mixed population of biologic-naive and biologic pretreated patients. The overall effectiveness of TNF inhibitors diminished with time, leading to decreased drug survival rates. Pooled drug survival rates after 60 months follow-up were 37% (infliximab), 48% (adalimumab), and 52% (etanercept). Further, in an observational study, when TNF inhibitors were used in combination with methotrexate, a longer drug survival was observed compared to TNF inhibitors alone. Conclusion. The findings of this systematic review indicated numerically lower drug discontinuation rates with etanercept than adalimumab, whereas infliximab had the highest rate. Further research is needed to understand the underlying mechanisms of treatment discontinuation with TNF inhibitors. 1. Introduction Over the past 10 to 15 years, new treatment paradigms in rheumatoid arthritis (RA) have been developed, including early diagnosis, intensive (“treat to target”) management using disease modifying antirheumatic drugs (DMARDs) alone or in combination, and the advent of targeted biologic therapies. These new paradigms have significantly improved patient outcomes, improving quality of life and reducing joint damage. Tumour necrosis factor (TNF) inhibitors were the first biologic drugs to be developed and have been used for >10 years. Five TNF inhibitors now have marketing authorization for the treatment of RA: adalimumab (ADA), certolizumab pegol, etanercept (ETN), golimumab, and infliximab (INF). It would be of clinical importance if one TNF inhibitor were to be more effective than the others, but there is a paucity of data about the relative effectiveness of these drugs—there have been no head-to-head randomized controlled trials comparing two or more TNF inhibitors. It is possible that short-term effectiveness is similar with all TNF inhibitors, but that long-term safety and effectiveness may differ. Furthermore, no reviews have been conducted to analyse drug survival rates of these
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