Comparative effectiveness of switching to alternative tumour necrosis factor (TNF) antagonists versus switching to rituximab in patients with rheumatoid arthritis who failed previous TNF antagonists: the MIRAR Study

Gómez-Reino, Juan J.; Maneiro, José Ramón; Ruiz, Jorge Rodríguez; Roselló, Rosa; Sanmarti, Raimón; Romero, Alejandro

doi:10.1136/annrheumdis-2012-201324

Cited by 75 publications

(28 citation statements)

References 8 publications

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“…Estimates of effectiveness in this retrospective claims-based analysis were consistent with the results from two prospective studies that compared TNFi cycling vs switching to the non-TNFi rituximab 16,17. In these studies, switching from a TNFi to a non-TNFi improved clinical outcomes more effectively than TNFi cycling.…”

Section: Discussionsupporting

confidence: 77%

“…One observational study reported that clinical improvement with switching to a non-TNFi relative to TNFi cycling occurred in the subgroup of patients who discontinued the initial TNFi because of inefficacy, but not among those who switched therapy because of intolerance 16. The other study reported that the clinical benefits of switching to a non-TNFi were observed vs TNFi cyclers who switched to adalimumab or infliximab, but not when TNFi cycling to etanercept was included in the comparison 17. A recent presentation of the results from a randomized, interventional study of 292 patients with an inadequate response to the first TNFi reported that switching to a non-TNFi resulted in significantly better efficacy than TNFi cycling, and the observed superiority was consistent over time and across outcome criteria 36…”

Section: Discussionmentioning

confidence: 99%

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Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

Bonafede¹,

Curtis²,

McMorrow³

et al. 2016

CEOR

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ObjectivesAfter treatment failure with a tumor necrosis factor inhibitor (TNFi), patients with rheumatoid arthritis (RA) can switch to another TNFi (TNFi cyclers) or to a targeted disease-modifying antirheumatic drug (DMARD) with a non-TNFi mechanism of action (non-TNFi switchers). This study compared treatment patterns and treatment effectiveness between TNFi cyclers and non-TNFi switchers in patients with RA.MethodsThe analysis included a cohort of patients from the Truven Health Analytics MarketScan Commercial database with RA who switched from a TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) either to another TNFi or to a non-TNFi targeted DMARD (abatacept, tocilizumab, or tofacitinib) between January 1, 2010 and September 30, 2014. A claims-based algorithm was used to estimate treatment effectiveness based on six criteria (adherence, no dose increase, no new conventional therapy, no switch to another targeted DMARD, no new/increased oral glucocorticoid, and intra-articular injections on <2 days).ResultsThe cohort included 5,020 TNFi cyclers and 1,925 non-TNFi switchers. Non-TNFi switchers were significantly less likely than TNFi cyclers to switch therapy again within 6 months (13.2% vs 19.5%; P<0.001) or within 12 months (29.7% vs 34.6%; P<0.001) and significantly more likely to be persistent on therapy at 12 months (61.8% vs 58.2%; P<0.001). Non-TNFi switchers were significantly more likely than TNFi cyclers to achieve all six of the claims-based effectiveness algorithm criteria for the 12 months after the initial switch (27% vs 24%; P=0.011).ConclusionAlthough the absolute differences were small, these results support switching to a non-TNFi targeted DMARD instead of TNFi cycling when patients with RA require another therapy after TNFi failure.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

Bonafede¹,

Curtis²,

McMorrow³

et al. 2016

CEOR

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show abstract

“…A clinical interpretation of this observation might be that after the failure of a monoclonal anti-TNF antibody one could consider switching to ETA, but when a patient has failed ETA as first TNFi, the choice of a monoclonal antibody as second TNFi might not have the same potential to lead to a clinically significant improvement. Indeed, other studies have shown that in the latter case it might be more beneficial to change to a biologic of a different mechanism of action 29 30. This might imply an underlying mechanism that could explain this finding: as it is known, ETA competitively inhibits the binding of both TNF and lymphotoxin-α to cell surface TNF receptors, rendering TNF biologically inactive,31 while INF and ADA bind and neutralise both soluble and membrane-bound TNF but not lymphotoxin.…”

Section: Discussionmentioning

confidence: 95%

Effectiveness of TNF inhibitor switch in RA: results from the national Swedish register

et al. 2014

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“…The MIRAR study and real-life data indicate that switching to RTX is a successful treatment option for patients with RA failing on TNF antagonists 12,14,15…”

Section: Rtx In Ramentioning

confidence: 99%

Current perspective on rituximab in rheumatic diseases

Schioppo¹,

Ingegnoli²

2017

DDDT

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The steadily increasing knowledge regarding pathogenetic mechanisms in autoimmune rheumatic diseases has paved the way to different therapeutic approaches. In particular, the market entry of biologics has dramatically modified the natural history of rheumatic chronic inflammatory diseases with a meaningful impact on patients’ quality of life. Among the wide spectrum of available biological treatments, rituximab (RTX), first used in the treatment of non-Hodgkin’s lymphoma, was later approved for rheumatoid arthritis and anti-neutrophil cytoplasmic antibodies-associated vasculitis. Nowadays, in rheumatology, RTX is also used with off-label indications in patients with systemic sclerosis, Sjögren’s syndrome and systemic lupus erythematosus. RTX is a monoclonal antibody directed to CD20 molecules expressed on the surfaces of pre-B and mature B lymphocytes. It acts by causing apoptosis of these cells with antibody- and complement-dependent cytotoxicity. As inflammatory responses to cell-associated immune complexes are key elements in the pathogenesis of several autoimmune rheumatic diseases, such an approach might be effective in these patients. In fact, RTX, by promoting the rapid and long-term depletion of circulating and lymphoid tissue-associated B cells, leads to a lower recruitment of these effector cells at sites of immune complex deposition, thus reducing inflammation and tissue damage. RTX is of the most interest to rheumatologists as it represents an important additional therapeutic approach. Thus, the advent in clinical practice of approved RTX biosimilars, such as CT-P10, may be of help in improving treatment access as well as in reducing costs.

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Comparative effectiveness of switching to alternative tumour necrosis factor (TNF) antagonists versus switching to rituximab in patients with rheumatoid arthritis who failed previous TNF antagonists: the MIRAR Study

Abstract: Optimal treatment for patients with RA failing on treatment with TNF antagonists may include RTX. This study suggests that the improvement in DAS28 is larger in patients treated with RTX than in those treated with monoclonal anti-TNF agents.

Cited by 75 publications

References 8 publications

Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

Effectiveness of TNF inhibitor switch in RA: results from the national Swedish register

Current perspective on rituximab in rheumatic diseases

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