Estudio comparativo de los fármacos Anti-TNFα (Infliximab, Adalimumab y Etanercept) en el tratamiento de patologías reumatoides de origen inflamatorio en pacientes mayores y menores de 65 años

Abstract

OBJECTIVE: 1. To describe the demographic and clinical characteristics of patients with rheumatoid diseases of inflammatory origin treated with anti-TNF drugs. 2. To establish the causes of the treatements suspension according to the drugs and the age of the patients. 3. To compare the duration of the 3 anti-TNF drugs in patientsover and under 65 years old. 4. To determine the main adverse effects of each drug in patients over and under 65 years old. METHODOLOGY: An observational retrospective longitudinal study was carried out at the University Clinical Hospital Virgen de la Arrixaca with an horizon time of 4 years (2013-2017). The subjects of the study include all patients who attended the outpatient clinics of the Hospital Pharmacy Service and the Rheumatology Day Hospital. Firstly, a review of the available databases was performed to obtain updated information of patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA). External Patientes dispensing program of Pharmacy Service was used to obtain dispensing data of the subcutaneous treatments (etanercept and adalimumab). In addition, the dispensing data of the intravenous treatment (infliximab) were obtained through the intravenous mixing program of the Pharmacy Service. The information was collected from the medical records, the discharge reports and the day hospital forms. CONCLUSIONS: 1. More than half of the patients who are treated with an anti-TNF drug are forced to change their treatment line so that, patients who start a first line of treatment with the drug adalimumab, change more times their treatment line than those who start with infliximab in both, under and over 65 years old, age groups. The percentage of patients with two or more treatment lines for the adalimumab drug is higher in elderly patients. However, the percentage of patients with two or more lines of treatment for the infliximab drug is higher in young patients. 2. Adalimumab is the most suspended drug due to its inefficiency in both age groups. On the one hand, etanercept is the most suspended drug due to adverse reactions and neoplasia in young patients. On the other hand, adalimumab is the most suspended drug due to adverse reactions and infliximab due to neoplasia in elderly patients. 3. The duration of the treatment is very different depending onwhich one of the three drugs is used. Infliximab is the most durable drug in global population and young patients groups (p<0,05). However, in elderly patients, etanercept is the most durable drug (no statistical significance was obtained). 4. The profile of adverse effects is different depending on the drug and the age of patients. In elderly patients, subcutaneous drugs are associated with the onset of cardiac disorders, urinary tract disorders and blood disorders. However, in young patients, subcutaneous drugs are associated with the onset of nervous system disorders and neoplasia.