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Objective  To compare, in real‐life settings, the retention rates of initial anti‐tumor‐necrosis factor ( TNF ) treatments (etanercept [ ETN ], adalimumab [ ADA ] and infliximab [ IFX ]) used as first‐line biotherapy for axial spondyloarthritis (axSpA), and evaluate treatment switches to another anti‐ TNF  inhibitor in the event of treatment failure.    Methods  We analyzed the medical records of all SpA patients (Assessment in Ankylosing Spondylitis International Working Group axial criteria) treated with  ETN ,  IFX  or  ADA  between 2001 and February 2015. Drug retention rates were calculated using the Kaplan‐Meier method and compared by means of the Cox extended model. Sub‐analyses were performed according to discontinuation reasons.    Results  Of the 249 SpA patients analyzed (135 radiographic cases, 114 non‐radiographic), 102 received  ETN , 62  ADA , and 85  IFX . In total, 103 discontinued treatment. The retention rates of  IFX ,  ADA  and  ETN  were 67%, 59% and 56% after 3 years; 62%, 42% and 47% after 5 years; 55%, 42% and 24% after 8 years; 53%, 42% and 12% after 10 years, respectively. In multivariate analyses, the predictive factors for retention were: low  BASDAI  score (hazard ratio [ HR ]: 1.02 [1.01‐1.04]), high C‐reactive protein levels ( HR : 0.98 [0.97‐0.99]), concomitant disease‐modifying therapy ( HR : 0.4 [0.21‐0.75]), and radiographic SpA ( HR : 1.5 [1.0‐2.52]). In total, 61 patients switched to another anti‐ TNF  therapy. No difference was observed among the three anti‐ TNF  therapies regarding median retention duration, although the retention rate proved higher for treatment switches from one monoclonal antibody to another.    Conclusion  The retention rate in SpA patients proved high, with retention for  IFX  superior to that of  ETN .

international journal of rheumatic diseases

Retention rates of adalimumab, etanercept, and infliximab as first‐ or second‐line biotherapies for spondyloarthritis patients in daily practice in Auvergne (France)