Anti–tumor necrosis factor α switching in rheumatoid arthritis and juvenile chronic arthritis

Favalli, Ennio Giulio; Arreghini, Marco; Arnoldi, C; Panni, Benedetta; Marchesoni, Antonio; Tosi, S; Pontikaki, Irene

doi:10.1002/art.20242

Cited by 26 publications

(19 citation statements)

References 4 publications

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“…The published studies are open-label and noncontrolled with few patients, most of whom suffer from rheumatoid arthritis. Nevertheless, the publications agree that the switch from one anti-TNF agent to another can be useful in cases where the first anti-TNF agent is stopped due to adverse effects or where there is a primary or secondary therapeutic failure [9,10,11,12]. In rheumatoid arthritis, it seems that better results can be achieved when the reason for the change is failure during therapy (also known as the escape phenomenon) or adverse effects, more than the primary failure [13].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Etanercept in Psoriatic Patients Previously Treated with Infliximab

et al. 2008

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Background: There are few data to enable us to ascertain whether switching to another systemic agent is useful in patients with psoriasis who have not responded favorably to a first systemic treatment. Objective: To evaluate the efficacy and safety of etanercept in patients with moderate-to-severe plaque psoriasis previously treated with infliximab. Methods: We analyzed data from patients with moderate-to-severe psoriasis and a poor primary or secondary response to infliximab, and who were later treated with etanercept. Results: Data were collected from 8 patients who were first treated with infliximab. At 54 weeks of therapy, 25% had a psoriasis area and severity index (PASI) of 75. At 24 weeks of therapy with etanercept, 75% had a PASI of 75. Consecutive administration of both therapies did not increase the number of adverse events. Limitations:The data should be regarded with caution due to the scant number of patients. Conclusions: Switching from infliximab to etanercept can be useful and safe in nonresponders.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Etanercept in Psoriatic Patients Previously Treated with Infliximab

et al. 2008

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“…In individual patients, these differences may explain the differential response to the 3 agents, although there is no direct evidence to support this. Indeed, there are now numerous reports in which it has been suggested that initiating therapy with a second anti-TNF␣ agent in patients who have failed therapy with a first agent (due to lack of efficacy or because of an AE) may be beneficial and not associated with an increased rate of AEs with the second agent (12)(13)(14)(15)(16)(17)(18)(19)(20). However, all of the studies to date have been based on small case series (the largest included only 37 patients), which makes it difficult to establish a substantive estimate of recurrent AEs and treatment inefficacy.…”

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confidence: 99%

Outcomes after switching from one anti–tumor necrosis factor α agent to a second anti–tumor necrosis factor α agent in patients with rheumatoid arthritis: Results from a large UK national cohort study

Hyrich

Lunt

Watson

et al. 2007

Arthritis & Rheumatism

379

215

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Objective. Patients with rheumatoid arthritis (RA) who experience treatment failure with one antitumor necrosis factor (anti-TNF) agent, due to either inefficacy or toxicity, are frequently switched to a second anti-TNF agent, although the benefits of switching are unknown. The present study was undertaken to compare drug continuation rates between the first course and second course of anti-TNF therapy.Methods. The study involved a prospective cohort of RA patients from a UK national register of new anti-TNF treatment starts (n ‫؍‬ 6,739; 876 starting adalimumab, 2,826 starting etanercept, and starting 3,037 infliximab). Over a mean 15 months of followup, 841 patients stopped taking the first drug due to inefficacy and 1,023 stopped the first drug due to toxicity, of whom 503 and 353, respectively, were switched to a second anti-TNF agent. Kaplan-Meier survival curves were plotted to determine continuation rates for each course, and Cox regression was used to compare each course for the risk of stopping and the reason for stopping (inefficacy or toxicity).Results. Overall, 73% of patients who switched to a second anti-TNF agent remained on the new therapy by the end of followup. First drug discontinuation due to inefficacy was associated with an increased rate of second drug discontinuation due to inefficacy (hazard ratio [HR] 2.7, 95% confidence interval [95% CI] 2.1-3.4) but not toxicity (HR 1.1, 95% CI 0.9-1.5). Similarly, first drug discontinuation due to toxicity was associated with an increased rate of second drug discontinuation due to toxicity (HR 2.3, 95% CI 1.9-2.9) but not inefficacy (HR 1.2, 95% CI 0.8-1.6).Conclusion. RA patients who are switched to a second anti-TNF drug have high rates of continuation, although among those who must discontinue treatment, the reasons for stopping a second drug are related to the reasons for stopping the first drug. This large data set from the UK provides the first estimates of the magnitude of these effects in patients with long-standing severe RA.

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“…1 Since that publication, a sizeable number of research articles have investigated this question, and the answers have generally been in the affirmative, implying that, yes, a switch of this type can benefit some patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] However, some reports reached less favourable conclusions, 17 18 and it can rightfully be asserted that none of those published studies, nor any of the many abstracts presented at international meetings on the topic, were controlled, prospective, randomised or blinded.…”

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confidence: 99%

Switching between anti-tumour necrosis factors: trying to get a handle on a complex issue

Vollenhoven¹

2007

Annals of the Rheumatic Diseases

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Anti–tumor necrosis factor α switching in rheumatoid arthritis and juvenile chronic arthritis

Cited by 26 publications

References 4 publications

Efficacy of Etanercept in Psoriatic Patients Previously Treated with Infliximab

Efficacy of Etanercept in Psoriatic Patients Previously Treated with Infliximab

Outcomes after switching from one anti–tumor necrosis factor α agent to a second anti–tumor necrosis factor α agent in patients with rheumatoid arthritis: Results from a large UK national cohort study

Switching between anti-tumour necrosis factors: trying to get a handle on a complex issue

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