Arends S, Lebbink HR, Spoorenberg A, et al. for drug discontinuation. Etanercept showed better survival rate than infliximab. The main reason for discontinuation of TNFi was inefficacy. Conclusions TNFi discontinuation rate of Korean patients with AS seems to be similar to those with the European patients. JTK3 Female sex, hip involvement, CRP, and the type of TNFi were associated with TNFi discontinuation. value outcomes 0.20 were included in the multivariate analysis. Kaplan-Meier analysis was used to visualize drug specific survival and log-rank test was used to compare the distributions. Adjusted and unadjusted HRs were estimated for infliximab verses etanercept, adalimumab versus etanercept, and infliximab versus adalimumab. values were corrected by Scheffes method due to multiple testing. All analyses were performed using SPSS version 19.0 (IBM Co., Armonk, NY, USA) and SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). Statistical significance was assigned when values were 0.05. RESULTS Characteristics of TNFi user compared with TNFi nonuser Of the 487 patients with AS, 128 patients were started on a TNFi during the follow-up period. Mean follow-up duration of 487 patients was 72.6 52.5 months. The baseline clinical characteristics of the patients with AS according to the TNFi use are presented in Table 1. Patients who started on TNFi during the follow-up period were younger at the disease onset, had more peripheral manifestations, and showed higher level of acute phase reactants than TNFi non-users at baseline. Interestingly, TNFi users had a higher BMI and prevalence of dyslipidemia than patients who were TNFi non-users. Table 1. Clinical characteristics of ankylosing spondylitis patients between TNFi user and non-user at baseline valuevalue= 0.035; adjusted = 0.107) but there was significance in multivariable analysis (HR, 3.69; 95% CI, 1.32 to 10.31; = 0.012; adjusted = 0.044). There was no statistical significance between adalimumab versus infliximab users (HR, 2.10; 95% CI, 0.84 to 5.23; = 0.110; adjusted = 0.279). Statistical significant was found in uses for the three TNFi (= 0.003), as shown in Fig. 1. Open in a separate window Physique 1. Kaplan-Meier drug survival curves of etanercept, adalimumab, and infliximab as a first tumor necrosis factor inhibitor discontinuation. Table 3. Clinical characteristics between the patients with continuation and discontinuation of first TNFi at the time of the first TNFi initiation valuevaluevaluevaluevalue= 0.021). The higher levels of adipokines could be associated with a higher inflammatory Indisulam (E7070) burden in obese patients with AS and ultimately result in more TNFi Indisulam (E7070) use during the treatment course. In the current study, the discontinuation of first TNFi was 21.9%, which is similar to the previous studies. Danish DANBIO registry reported that discontinuation rate Indisulam (E7070) of TNFi was 37% (310/842) [14]. A Finnish group reported that this TNFi discontinuation rate was 21% (49/229) within 2 years of follow-up in their cohort of patients [15]. Norwegian study of 249 patients with AS reported the discontinuation rate of 22.5% and another study reported the same variable as 14.9% (77/514) [16,17]. Thus, the TNFi discontinuation rate of Korean patients from our study seems to be similar to those with the European patients. Most of Indisulam (E7070) the patients who discontinued the first TNFi due to insufficient efficacy showed good response to second TNFi except one patient. This patient was 38 years old male with high disease activity and both hip arthritis. He discontinued the second TNFi due to secondary failure and changed to the third TNFi. Although the symptom was not fully resolved (BASDAI 4), he is maintaining on the third TNFi. In addition, there were two patients who used the third TNFi in the adverse event group. One patient experienced injection site reaction with two TNFis (etanercept, adalimumab). After switching to the third TNFi (infliximab), injection site reaction never developed. The other patient experienced psoriasis with two TNFis (adalimumab, etanercept). The patient did not developed psoriasis with the third TNFi (golimumab). We found that presence of hip arthritis and high CRP was associated with drug discontinuation. Hip involvement is usually common manifestation of AS and hip involvement in AS increases the burden and is associated with poor prognosis [18]. Elevated serum level of Indisulam (E7070) CRP is usually a risk factor for radiographic progression in AS [19]. Hip involvement is usually associated with advanced axial disease, elevated.