Which subgroup of rheumatoid arthritis patients benefits from switching to tocilizumab versus etanercept after previous infliximab failure? A retrospective study

Wakabayashi, Hiroki; Hasegawa, Masahiro; Nishioka, Yosuke; Sudo, Akihiro; Nishioka, Kusuki

doi:10.1007/s10165-011-0485-9

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Although our study protocol included all eight bDMARDs available at the time of the chart review, our final sample sizes were too small to allow for meaningful comparisons between individual bDMARDs (on average, 26 treatments per bDMARD). In other studies, responses were dependent on which bDMARDs were included in the comparisons [ 18 , 19 ]. We also did not assess the impact of choice of concomitant non-bDMARD on study outcomes.…”

Section: Discussionmentioning

confidence: 99%

Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis

Bergman

Elkin

Ogale³

et al. 2014

Rheumatol Ther

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IntroductionThe aim of this study was to compare the response between subsequent use of anti-tumor necrosis factor α (anti-TNF) agents and biologic disease-modifying anti-rheumatic drugs (bDMARD) with other mechanism of action (MOA) in rheumatoid arthritis (RA) patients with history of anti-TNF treatment as their first bDMARD.MethodsA retrospective chart review was conducted at eight community-based rheumatology practices in the United States in 2012. Routine Assessment of Patient Index Data 3 (RAPID3) response was measured by comparing baseline and 6-month scores. Poor response was defined as decrease <1.8 points, follow-up score >12, or treatment discontinuation before 6 months. Percentages of patients with good and good or moderate RAPID3 response were compared for second and third biologics. Multivariate models controlled for potential confounders.ResultsOf 176 patients whose charts were abstracted, 122 (69.3%) received another anti-TNF agent after they discontinued their first anti-TNF. RAPID3 scores were available for 160 patients. A patient receiving a second bDMARD with another MOA had a higher good or moderate response than a patient receiving anti-TNF (53.5 vs. 30.7%, p = 0.01). In the multivariate models, treatment with another MOA was more likely to produce a good RAPID3 response [odds ratio (OR), 2.42; 95% confidence interval (CI), 1.05–5.58] or a good or moderate response (OR, 2.21; 95% CI, 1.23–3.97) than treatment with an anti-TNF.ConclusionIn patients who have discontinued anti-TNF agents as their first bDMARD, RAPID3 response rates are better for those receiving agents with a different MOA rather than another anti-TNF. Physicians should consider using a bDMARD with a different MOA as the next bDMARD for RA patients whose anti-TNF agent has failed.Electronic supplementary materialThe online version of this article (doi:10.1007/s40744-014-0002-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis

Bergman

Elkin

Ogale³

et al. 2014

Rheumatol Ther

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“…The RA status was evaluated at 12, 24, and 52 weeks after the initiation of GLM treatment by the serum C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR). DAS 28-ESR and DAS28-CRP were used to evaluate RA disease activity compared with baseline; the DAS28 was calculated according to the standard formula [ 14 , 15 ]. The GLM continuation rates at 52 weeks were also examined.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Switching from Infliximab to Subcutaneous Golimumab in Patients with Rheumatoid Arthritis to Control Disease Activity or Adverse Events

Wakabayashi

Inada²,

Nishioka

et al. 2016

Drugs R D

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BackgroundSome rheumatoid arthritis (RA) patients initially respond to treatment with infliximab (IFX), but subsequently their responsiveness decreases.ObjectivesOur objective was to evaluate the efficacy and safety of switching from IFX to subcutaneous golimumab (GLM-SC) in RA patients.MethodsThirty-three patients who had been treated for a mean 4.4 years with IFX (3–6 mg/kg/8 weeks) were switched to GLM-SC to control disease activity or adverse events. The patients with low disease activity (LDA) or remission were divided into two groups: the LDA group and the LDA every 8 weeks (q8w) group, which included patients with LDA or remission who switched to GLM therapy with 50 mg at 4- and 8-week intervals, respectively. The moderate disease activity (MDA) group included patients with MDA who switched to GLM therapy with 50 mg at 4-week intervals. Effects of the IFX to GLM-SC switch were evaluated at weeks 12, 24, and 52 after switching.ResultsThe mean disease activity score 28-ESR and -C-reactive protein values in the LDA and LDAq8w groups were maintained from baseline throughout the 52-week treatment period. The mean disease activity score 28 values at 12, 24, and 52 weeks in the MDA group were improved significantly compared with baseline. Treatment discontinuations due to adverse events occurred in one patient in the MDA group, and no serious adverse events occurred during the observation period in the LDA group or the LDAq8w group. The GLM continuation rates at 52 weeks were 100% in the LDA and LDAq8w groups and 83.3% in the MDA group. Thus, GLM-SC treatment regimens were effective in controlling disease activity and improving the clinical response related to adverse events caused by IFX.ConclusionThe clinical efficacy of GLM-SC was sustained or improved in patients who switched from IFX without serious safety concerns.

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“… 14 A retrospective study reported that switching from first TNFi (infliximab) to either another MOA bDMARD (tocilizumab) or second TNFi (etanercept) in patients with RA showed no significant difference in efficacy, as measured by disease activity. 15 However, randomized controlled trials suggested that switching to non-TNFi biologic agents, such as rituximab, tocilizumab, and abatacept, could be an alternative option for RA patients with an inadequate response to one or more TNFis. 16 – 18 Moreover, an observational study reported that, after failure of a first TNFi for RA, switching to a new MOA bDMARD (rituximab) was more effective than cycling to another TNFi.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy and risk of discontinuation between non-TNF-targeted treatment and a second TNF inhibitor in patients with rheumatoid arthritis after first TNF inhibitor failure

Park

Choi

Kang

et al. 2022

Therapeutic Advances in Musculoskeletal

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Objectives: Despite improved care for rheumatoid arthritis (RA) patients, many still experience treatment failure with biologic disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic DMARDs [tsDMARDs; typically Janus kinase inhibitors (JAKi)], and eventually switch to other agents. We compared the efficacy of a second tumor necrosis factor inhibitor (TNFi) and non-TNF-targeted treatment as the second-line treatment in patients showing an insufficient response to the first TNFi. Methods: Patients were included if they had received at least one prescription for a TNFi, and at least one follow-up prescription for a second TNFi or non-TNF-targeted treatment after discontinuation of the first drug. In total, 209 patients were analyzed, including 69 with a second TNFi and 140 with a non-TNF-targeted treatment (106 non-TNFi biologics and 34 JAKi). Cox regression was used to estimate the hazard ratio (HR) for discontinuation. Results: The mean follow-up period after switching was 28.0 (range: 0–80) months and 24.4% of the 209 patients switched or discontinued the second drug. In multivariate Cox proportional hazard analysis, the non-TNF-targeted treatment group had a lower likelihood of discontinuing their treatment than the second TNFi group [HR = 0.326, 95% confidence interval (CI): 0.170–0.626, p = 0.001]. When analyzed separately, the risk of discontinuation was significantly lower in both the non-TNFi biologic (HR = 0.318, 95% CI: 0.160–0.633, p = 0.001) and JAKi (HR = 0.356, 95% CI: 0.129–0.980, p = 0.046) groups than in the second TNFi group. Conclusion: Our study supported switching to a non-TNF-targeted treatment instead of TNF cycling in patients with RA showing an inadequate response to initial TNFi.

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Which subgroup of rheumatoid arthritis patients benefits from switching to tocilizumab versus etanercept after previous infliximab failure? A retrospective study

Cited by 4 publications

References 26 publications

Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis

Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis

Efficacy of Switching from Infliximab to Subcutaneous Golimumab in Patients with Rheumatoid Arthritis to Control Disease Activity or Adverse Events

Comparison of the efficacy and risk of discontinuation between non-TNF-targeted treatment and a second TNF inhibitor in patients with rheumatoid arthritis after first TNF inhibitor failure

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