Outcomes of switching anti-TNF drugs in rheumatoid arthritis—a study based on observational data from the Finnish Register of Biological Treatment (ROB-FIN)

Abstract

The aim of this study was to assess, based on observational data from the Finnish Register of Biological Treatment, the outcomes of switching an initial tumor necrosis factor (TNF) blocker to another in the treatment of rheumatoid arthritis (RA). RA patients, who started biological therapy with a TNF blocker between May 1999 and April 2009 and who switched to another TNF blocker, were studied (n=479). The outcomes were assessed according to the reason for and type of the switch. Outcome assessments included American College of Rheumatology 50 responder index (ACR50) response at 3 months after the switch, treatment duration of the second TNF blocker, and swollen joint counts, CRP and DAS28 score at the 3 months, best and last observations of the first and second TNF blocker, respectively. In those who switched due to lack of effectiveness (LOE), the disease activity parameters fell significantly from baseline upon use of infliximab or adalimumab, but had increased prior to the switch. Switching to another TNF blocker (etanercept or adalimumab) restored the response initially achieved with the first TNF blocker. The disease activity parameters fell significantly from baseline upon use of etanercept, and were maintained but not further improved after switching to adalimumab. TNF blocker switching seemed to be most beneficial in secondary LOE (defined as loss of ACR50 response). In those who switched due to adverse events (AE) or other reasons, a similar degree of response as had been achieved with the first agent was also achieved and maintained with the second agent. The results suggest that a second TNF blocker can restore the response in cases of secondary LOE and maintain it after switching due to an AE.

Use of a pLDH-based dipstick in the diagnostic and therapeutic follow-up of malaria patients in Mali

“…This difference may be explained by the difference in the accuracy of the thick smear reading and the improvements made in the design of the second generation OptiMal-IT test [17]. Palmer et al [18] and Dolo et al [19] observed results similar to our findings in field studies conducted respectively in Honduras and in Mali with analogous sensitivity, specificity and Kappa concordance. Our thick smears were read by 2 independent readers with one at the field site and a second more experienced reader in the laboratory in Bamako.…”

Differential drug retention between anti-TNF agents and alternative biological agents after inadequate response to an anti-TNF agent in rheumatoid arthritis patients

“…A recent cohort study suggested a better effectiveness of switching to an alternative aTNF after secondary failure than primary failure which supports our findings. However, it did not compare aTNF with non-aTNF-Bio discontinuation rates 12. Pathophysiological mechanisms of primary failure remain unclear.…”

Cytokines as Therapeutic Targets in Rheumatoid Arthritis and Other Inflammatory Diseases

“…There are currently limited trial data to inform this decision, so this issue has been addressed mainly using observational data from registries and similar studies. These data suggest that sequential switching to an alternative TNF inhibitor will reduce disease activity and improve functional scores, but that response rates, probability of response, and drug survival are all lower than with first anti-TNF agent (Gomez-Reino and Carmona, 2006;Hyrich et al, 2007;Virkki et al, 2011;Chatzidionysiou et al, 2014). The best results were seen with switches from infliximab to etanercept for reasons of secondary inefficacy (Chatzidionysiou et al, 2014).…”