6 years of experience with TNF blockers in Lithuania

Abstract Objective This report presents 6 years of experience with TNF blockers use at the Vilnius University Hospital Santariskiu klinikos. Results The first anti-TNF agent introduced in Lithuania in 2000 was Infliximab. Until 2004 were only up to 10 patients per year treated with Infliximab. Since 2005 the budget has increased and we included Eternecept and, most recently, Adalimumab for the treatment of rheumatic patients. The number of patients treated with anti-TNF in Lithuania grows every year, in October 2007, 176 patients were receiving anti-TNFs. In the past 6 years we treated a total of 115 patients (93 infliximab, 14 etanercept, 8 adalimumab), 42 males, 73 females at Vilnius University Hospital Santariskiu Klinikos. Median age is 41.8. Most of these patients were RA patients (72), but we also had 24 with AS, and 19 patients with PsA. Disease duration before anti-TNF therapy ranged from 1 to 33 years (the median - 9.4 years). These patients were the most challenging to us because they went through all the traditional DMARDS and their combinations before being put on anti-TNF therapy. The number of DMARDS for one patient is from 3 to 6 (median – 3,9). Number of discontinuations of the therapy in total is 35 out of 115 (30,4%). The largest proportion of discontinuation of treatment with Infliximab is due to financial aspects (18 of 93; 19,35%). The discontinuations of Infliximab due to adverse events were rare (6 of 93; 6,45%): 2 infusion reactions, 1 exacerbation of CMV infection, 1 ischemic stroke after first infusion, 1 diverticulitis, 1 osteomyelitis. In 5 cases (5,38%) of treatment with infliximab we did not achieve a sufficient effect. The discontinuation of treatment with etanercept because of infection in 3 cases of 14 (21,43%) and there was 1 case (7,14%) of non effective treatment. 1 patient of 8 (12,5%) treated with adalimumab stopped treatment because of non effectiveness and 1 patient stopped treatment due to polyneuropathy. Conclusions Anti-TNFs were very effective for majority of rheumatic patients despite very high activity and advanced stage of the disease.Side effects were rare.Discontinuation mostly due to financial reasons and lack of efficacy. General trend in Lithuania regarding use of biologicals is favorable. Every year the number of treated patients is increased as well as anti-TNF availability.