Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Effect of Switching AntiTumor Necrosis Factor Agents on Clinical Outcomes for Patients with Rheumatoid Arthritis.
Goran2, Amir, Roy1, Sanjoy, DiBonaventura2, Marco, Ertl2, Jochen, Cifaldi1, Mary
Background and Purpose:
Tumor necrosis factor antagonists (anti-TNFs) have led to better management of rheumatoid arthritis (RA), and their efficacy is well-established for patients who have failed disease-modifying antirheumatic drugs (DMARDs). The utility of switching to a second anti-TNF agent, after the first fails, is therefore a topic of immense clinical interest. We assessed outcomes of switching from 1 anti-TNF agent to another on a range of clinical measures.
Data were extracted from medical charts of patients with RA who were treated with an anti-TNF agent and then switched to a second biologic DMARD by rheumatologists in the United States. Outcomes frequently used in clinical practice were assessed: swollen and tender joint counts (SJC and TJC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and physician-reported severity. Mixed models assessed improvements over time, from initiation to discontinuation of the first and then the second anti-TNF agent, controlling for age, sex, time on and between treatments, years since diagnosis, concomitant use of methotrexate, psychiatric comorbidity, and Charlson Comorbidity Index. Subgroups were also analyzed by reason for switching in the following order: lack of/inadequate response to the first agent, side effects/tolerability issues, or other reasons (eg, compliance or cost).
Data were analyzed for 399 patients with RA who switched to a second biologic agent after a mean (SD) of 1.6 (1.7) years on the first therapy. Of 215 who switched to a second anti-TNF agent, 148 switched for lack of/inadequate response, 31 for intolerability, and 36 for other reasons. Mean age was 51.3 years, mean RA duration was 6.5 years, 71.2% were women, and 80.9% were white. After failure on the first anti-TNF agent, patients treated with a second anti-TNF agent for a mean (SD) of 1.3 (1.6) years achieved overall improvements of 65.6%, 69.5%, and 25.5% for TJC, SJC, and severity, respectively (all p<0.001); improvements were significantly greater with the second anti-TNF agent compared with the first. CRP (54.2%) and ESR (46.5%) showed similar overall improvements (both p<0.001), but there was no difference before and after switching to the second anti-TNF agent. Continued improvement after switching anti-TNF therapies was observed for all patients, except for those who switched due to other reasons. For patients who switched due to inadequate response, significantly greater improvement on all measures was observed during therapy with the second anti-TNF agent compared with the first, whereas the intolerability group experienced steady and significant improvements on both the first and second anti-TNF agent.
For patients with RA who failed a first anti-TNF agent, including those who failed because of lack of response or tolerability issues, significant improvements on SJC, TJC, ESR, CRP, and disease severity were observed after switching to a second anti-TNF agent. Overall improvements were similar or better than those observed in most randomized, controlled trials of an anti-TNF agent as the first biologic therapy, thus demonstrating the value of switching to a second anti-TNF when the first fails.
To cite this abstract, please use the following information:
Goran, Amir, Roy, Sanjoy, DiBonaventura, Marco, Ertl, Jochen, Cifaldi, Mary; Effect of Switching AntiTumor Necrosis Factor Agents on Clinical Outcomes for Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :382