Periodontitis and etanercept discontinuation risk in anti-tumor necrosis factor-naive rheumatoid arthritis patients: A nationwide population-based cohort study

Hsin Hua Chen, Der Yuan Chen, Kuo Lung Lai, Yi Ming Chen, Yiing Jenq Chou, Pesus Chou, Ching Heng Lin, Nicole Huang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Objective: The objective of this study was to investigate the association between periodontitis (PD) and etanercept (ETN) discontinuation in anti-tumor necrosis factor (anti-TNF)-naive patients with rheumatoid arthritis (RA). Methods: This retrospective nationwide population-based cohort study identified 3359 anti-TNF-naive patients with RA (age at diagnosis ≥16 years) in whom ETN treatment was initiated using administrative data. We identified PD exposure within 5 years before ETN initiation and during ETN treatment. Cox proportional hazard models were used to assess ETN discontinuation risk associated with PD within 5 years before ETN initiation, shown as hazard ratios with 95% confidence intervals (CIs). Stratified analyses were performed on the basis of PD during ETN treatment to avoid violating the Cox regression assumptions. Results: Patients with PD history during the 5 years before ENT initiation had a higher risk of ETN discontinuation compared with those without such history; the hazard ratios of ETN discontinuation were 1.27 (95% CI, 1.01-1.60) and 1.17 (95% CI, 1.06-1.30) among patients with and without PD during ETN treatment, respectively. Other risk factors included age older than 65 years and daily prednisolone dose greater than 10 mg/d within 1 year before ETN initiation. Concomitant methotrexate, leflunomide, salazopyrin, or hydroxychloroquine administration had a protective effect on ETN discontinuation in patients without PD during ETN treatment, but the protective effect by leflunomide, salazopyrin, and hydroxychloroquine was attenuated in patients with PD during ETN treatment (P for interaction <0.05). Conclusions: A PD history within 5 years before ETN administration was associated with increased ETN discontinuation risk in anti-TNF-naive patients with RA.

Original languageEnglish
Pages (from-to)432-438
Number of pages7
JournalJournal of Clinical Rheumatology
Volume19
Issue number8
DOIs
StatePublished - Dec 2013

Keywords

  • Drug survival
  • Etanercept
  • Periodontitis
  • Rheumatoid arthritis
  • Risk

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