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.

TNF Switch after Failure of One or More TNF InhibitorsResults of an Observational Study.

Chatzidionysiou2,  Katerina, Van Vollenhoven1,  Ronald

Karolinska University Hospital, Stockholm, Sweden
Karolinska University Hospital, Stockholm


The optimal alternative treatment for those patients who fail an anti-TNF is not clearly described. The purpose of this study was to determine whether patients who had failed one or more anti-TNFs benefit from switching to another anti-TNF and whether the type of switch is significant.


The Stockholm registry "STURE" was used and treatment results at 3 and 6 months were analysed according to DAS28 reductions and EULAR responses by type of TNF switch, number of switches and reason for discontinuation (lack of efficacy or intolerance).


850 patients who had previously failed a TNF inhibitor switched to another biologic: 679 switched to an alternative TNF antagonist, 308 to etanercept, 294 to adalimumab and 77 to infliximab. By the end of 6 months statistically significant improvements in DAS28 were observed (p<0.0001 for etanercept and adalimumab and p=0.006 for infliximab). At 3 and 6 months significantly greater reductions in DAS28 were observed for etanercept compared to the anti-TNF monoclonal antibodies taken together (1.56 ± 1.34 vs. 1.14 ± 1.26, p=0.005 and 1.58 ± 1.46 vs. 1.15 ± 1.4, p=0.01, respectively). At 6 months the percentage of EULAR good/moderate/no responders was 16.6/38.7/44.7 for the anti-TNF monoclonal antibodies and 29.4/35.3/35.3 for etanercept (p=0.009). Table 1 summarizes the response to therapy according to the type of switch. The difference between etanercept and monoclonal antibodies was observed both for the second and the third switch. At 6 months the subgroup of patients who discontinued previous anti-TNF monoclonal antibody for reason of loss of efficacy achieved significantly better results when switched to etanercept than when switched to an alternative antibody (DDAS28 2.11 ± 1.5 vs. 1.09 ± 1.43, p=0.008).


In this observational cohort patients having failed anti-TNF therapy do benefit from switching to other TNF inhibitors. Better results were observed when switching from a TNF monoclonal antibody to etanercept rather than to an alternative antibody, especially when the reason for failure of the first was loss of efficacy.

Table 1. Response to therapy with an alternative TNF inhibitor (monoclonal antibody or soluble TNF receptor) according to DAS28 reductions and EULAR response during the first 6 months.

 TNF monoclonal ab ¯ TNF monoclonal abTNF monoclonal ab ¯ EtanerceptEtanercept ¯ TNF monoclonal ab
DDAS28 at 3 months1.15 ± 1.511.56 ± 1.331.15 ± 1.12
DDAS28 at 6 months1.24 ± 1.51.57 ± 1.451.22 ± 1.25
EULAR Good response20.9%29.4%15.4%
EULAR Moderate response29.8%35.3%41.9%
EULAR No response49.3%35.3%42.7%

To cite this abstract, please use the following information:
Chatzidionysiou, Katerina, Van Vollenhoven, Ronald; TNF Switch after Failure of One or More TNF InhibitorsResults of an Observational Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :418
DOI: 10.1002/art.28187

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