Which patients with rheumatoid arthritis, spondyloarthritis, or juvenile idiopathic arthritis receive TNF-alpha antagonists in France? The CORPUS cohort study

Objective Limited information is available about the characteristics of patients with active inflammatory rheumatic diseases who start TNF-alpha antagonist therapy. Our objective was to assess TNF-alpha antagonist prescription patterns in this context in France. Methods Between 2007 and 2009, 102 rheunzatologists, internists, and pediatricians in French university hospitals and private practice prospectively recruited biologics-naive patients with active rheumatoid arthritis (RA) (DAS28>3.2 despite methotrexate therapy), spondyloarthritis (SA) (BASDAI >= 4 despite non-steroidal anti-inflammatory drug [NSAID] use), and juvenile idiopathic arthritis (TIA) (unresponsive to methotrexate). Patients were monitored prospectively for I year. Results Of the 543 RA, 287 SA, and 53 JIA patients included in the study, 382 RA, 171 SA, and 28 JIA patients had complete follow-up data available after I year. Among these patients, 110/382 (28.8%) with RA, 81/171 (47.4%) with SA, and 26128 (92.9%) with JIA received at least one TNF-alpha antagonist dose during the 1-year follow-up. The main physician-reported reason for not starting TNF-alpha antagonists in patients with RA or SA was low disease activity (72% for RA and 67% for SA); absence of TNF-alpha antagonist therapy was due to patient refusal in only 10% and to contraindications in 6% to 7% of cases. Conclusion In France, TNF-alpha antagonists, which are fully reimbursed by the national health insurance system, were used almost routinely in NA patients unresponsive to methotrexate and were given to about half the SA patients with BASDAL >= 4 despite NSAID use and a third of RA patients with DAS28>3.2 despite methotrexate therapy.