Adverse events leading to discontinuation included malignancy (3.7%, 1 patient taking infliximab), infection (13.8%, n=4), tuberculosis (11.1%, n=3), skin eruption (44.4%, n=12), cardiovascular complication (3.7%, n=1), and other causes (22.2%, n=6; pregnancy 2, uveitis 4). In Pyr6 the univariate Cox proportional hazard analysis, the drug discontinuation rate differed among the three TNF inhibitors in RA patients and etanercept (HR, 0.359; 95% CI, 0.188-0.688) had a lower drug discontinuation rate than infliximab (Table 3, Fig. value of less than 0.10 in the univariate analysis were included in the multivariate analysis. Statistical analyses were performed using the SPSS software package. A value of less than 0.05 was considered to indicate statistical significance. Ethics statement This study was approved by the institutional evaluate table of Chonnam National University Hospital Igf1r in accordance with the Helsinki II Declaration (KC09OISI0258). Informed consent was waived. RESULTS A total of 114 RA patients treated with TNF inhibitors from December 2002 to November 2011 were recognized, with 22 patients receiving infliximab, 39 etanercept, and 48 adalimumab; 310 AS patients were identified during the same period, with 115 patients receiving infliximab, 116 etanercept, and 79 adalimumab. In the RA patients, the mean age at the start of TNF inhibitor was 51.4 (SD14.1) yr, 80.5% (n=91) were women, and the disease duration of RA was 4.82 yr (SD4.06). RF and anti-CCP were positive in 93.9% and 86.0% of the patients, respectively. Regarding concomitant medications, 93.9% (n=107) of the patients were taking corticosteroids and 83.3% (n=95) were taking methotrexate (MTX). The DAS 28 at baseline was 7.001.07. There were no significant differences among the three treatment groups with regard to age, gender, disease period, RF and anti-CCP positivity, DAS 28, and concomitant medications. The baseline characteristics of the RA patients are shown in Table 1. Table 1 Demographic and clinical features of the patients with rheumatoid arthritis receiving TNF inhibitors Open in a separate window Unless specified normally, data are shown as the meansSD. DAS, disease activity score. In the AS patients, the mean age at the initiation of TNF inhibitors was 35.4 yr (SD11.8), 81.3% (n=252) were men, and the disease duration of AS was 3.49 yr (SD5.22). The patients treated with infliximab were older than those treated with etanercept or adalimumab ( em P /em =0.032), and the patients treated with etanercept were more often male than those treated with infliximab or adalimumab ( em P /em =0.014). The disease duration was longer for patients treated with etanercept than for adalimumab and infliximab ( em P /em =0.032). MTX and other disease-modifying anti-rheumatic drugs (DMARDs) were used more commonly in patients treated with infliximab than in those treated with etanercept or adalimumab ( em P /em =0.005 and em P /em =0.003, respectively). The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were higher in patients receiving infliximab than those receiving etanercept or adalimumab ( em P /em =0.014 and Pyr6 em P /em =0.038, respectively). Table 2 shows the baseline characteristics of the AS patients. Table 2 Demographic and clinical features of the patients with ankylosing spondylitis receiving TNF inhibitors Open in a separate window Unless specified normally, data are shown as the meansSD. BASDAI, bath ankylosing spondylitis Pyr6 disease activity index. Of the 114 RA patients included in the analysis, 64 discontinued the first TNF inhibitor after a imply of 33.8 (range 0-77) months; the number of patients who were prescribed infliximab, etanercept, and adalimumab was 19, 17, and 28, respectively. The most common cause of TNF inhibitor discontinuation was inefficacy, which was reported by 43 (67.2%) patients for all those TNF inhibitors: 13 for infliximab, 12 for etanercept, and 18 for adalimumab. Adverse events occurred in 9 (14.1%) patients, including skin eruption in three, contamination in five, and aggravation of heart failure in one patient. Among the AS patients, 65 (21.0%) discontinued the TNF inhibitors: 30 for infliximab, 24 for etanercept, and 11 for adalimumab. The reasons for discontinuation were adverse events (39.7%, n=27), inefficacy (33.3%, n=21), intention of patients (9.5%, n=6), economic status (11.1%, n=7), hospitalization (3.2%, n=2), and lost to follow-up (3.2%, n=2). Adverse events leading to discontinuation included malignancy (3.7%, 1 patient taking infliximab), infection (13.8%, n=4), tuberculosis (11.1%, n=3), skin eruption (44.4%, n=12), cardiovascular complication (3.7%, n=1), and other causes (22.2%, n=6; pregnancy 2, uveitis 4). In the univariate Cox proportional hazard analysis, the drug discontinuation rate differed among the three TNF inhibitors in RA patients and etanercept (HR, 0.359; 95% CI, 0.188-0.688) had a lower drug discontinuation.