@article {Lau874, author = {Lau, Arthur N. and Thorne, J. Carter and Movahedi, Mohammad and Rampakakis, Emmanouil and Cesta, Angela and Li, Xiuying and Couto, Sandra and Sampalis, John and Bombardier, Claire and ,}, editor = {Pope, Janet and Cividino, Alfred and Purvis, Jane and Ahluwalia, Vandana and Bajaj, Sangeeta and Karasik, Arthur and Chow, Andrew and Hanna, Brian and Alderdice, Catherine and Khalidi, Nader and Shickh, Ali and Leung, Frances and Kuriya, Bindee and Keystone, Edward and Hochman, Jackie and Akhavan, Pooneh and Soucy, Elaine and Leung, Felix and Mody, Ami and Montgomery, Angela and Aubrey, Michael and Ng, Edward and Blumer, Heather McDonald and Ahmad, Zareen and Matsos, Mark and Carmona, Raj and Mittoo, Shikha and Kagal, Allan and Bhavsar, Sankalp and Bookman, Arthur and Albert, Lori and Shaikh, Saeed and Stein, Jonathan and LeRiche, Nicole and Thompson, Andy and Rohekar, Gina and Rohekar, Sherry and Rai, Raman and Pavlova, Viktoria and Ahluwalia, Vandana and Bajaj, Sangeeta and Dixit, Sanjay and Mulgund, Manisha and Cohen, Dana and Ciaschini, Patricia and Carette, Simon and Johnson, Sindhu and Haroon, Nigil and Samadi, Nooshin and Perlin, Louise and Shupak, Rachel and Mahendira, Dharini and Ruban, Thanu and Bobba, Raja and Smith, Douglas and Karsh, Jacob and Jaroszynska, Anna and Haaland, Derek and Larche, Margaret and Ahluwalia, Vandana and Bajaj, Sangeeta and Joshi, Raman and Papneja, Tripti and Cabral, Antonio and Aydin, Sibel and Midzic, Ines and Milman, Nataliya and Faraawi, Rafat and Brophy, Julie and Bell, Mary and Choy, Grey and Sandhu, Sharron and McKeown, Emily and Chow, Shirley}, title = {Effect of Concomitant Disease-modifying Antirheumatic Drugs and Methotrexate Administration Route on Biologic Treatment Durability in Rheumatoid Arthritis: OBRI Cohort Results}, volume = {46}, number = {8}, pages = {874--886}, year = {2019}, doi = {10.3899/jrheum.180486}, publisher = {The Journal of Rheumatology}, abstract = {Objective. Prior studies have suggested that concurrent conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy enhances the efficacy of biologic DMARD (bDMARD). Here, we assessed the effect of concomitant csDMARD use and methotrexate (MTX) route of administration on time to bDMARD discontinuation in a large Canadian (Ontario), observational, rheumatoid arthritis (RA) cohort.Methods. Patients from the Ontario Best Practices Research Initiative (OBRI) who initiated bDMARD therapy and had >= 1 followup assessment were included. The effect of concomitant csDMARD use (primary analysis) and MTX route of administration (secondary analysis) on bDMARD discontinuation owing to (1) any reason, (2) ineffectiveness, (3) adverse events (AE), and (4) both (2) and (3), were assessed with multivariate Cox regression.Results. Among the 814 patients included, 153 (18.8\%) received bDMARD monotherapy and 661 (81.2\%) combination csDMARD/bDMARD therapy. Over a mean followup of 1.9 years, bDMARD were discontinued in 38.7\% of patients. In multivariate analysis, there was a nonsignificant trend toward lower discontinuation for the csDMARD/bDMARD group compared to bDMARD monotherapy for any reason (HR 0.76, 95\% CI 0.55{\textendash}1.05) and owing to ineffectiveness/AE (HR 0.73, 95\% CI 0.50{\textendash}1.06). Further, patients taking combination therapy had significantly lower risk of bDMARD discontinuation due to AE (HR 0.43, 95\% CI 0.24{\textendash}0.76). In the secondary analysis, no statistical association between MTX dose or route of administration and bDMARD durability was observed.Conclusion. Concomitant csDMARD use was associated with a significantly lower hazard for bDMARD discontinuation due to AE among patients with RA followed in routine clinical practice in Ontario, Canada. Neither MTX route of administration nor dose were significant predictors of bDMARD durability.}, issn = {0315-162X}, URL = {http://www.jrheum.org/content/46/8/874}, eprint = {http://www.jrheum.org/content/46/8/874.full.pdf}, journal = {The Journal of Rheumatology} }