Comparison of long-term efficacy between biological agents following tumor necrosis factor inhibitor failure in patients with rheumatoid arthritis: a prospective cohort study

Abstract

Background: Currently, there is contradictory evidence regarding the best strategy to follow after discontinuation of a first biological agent in patients with rheumatoid arthritis (RA). We aimed to compare the long-term efficacy of switching to a second tumor necrosis factor inhibitor (TNFi) versus biopharmaceuticals with other mechanisms of action (non-TNFi) in patients with RA who previously failed a first TNFi. Methods: This prospective cohort study analyzed data from 127 patients who discontinued a previous TNFi between 1999 and 2016. Disease activity was assessed at baseline and at 6, 12, and 24 months (m-6, m-12, m-24) after switching. Primary outcome was the proportion of patients achieving good/moderate EULAR response (E-resp). Factors associated with clinical outcomes were assessed using univariate and multivariate logistic regression models. Results: Seventy-seven (61%) patients received a second TNFi and 50 (39%) switched to a non-TNFi. At m-6 and m-12, no differences were observed between groups; nevertheless, at m-24, the proportion of patients with E-resp was higher in the non-TNFi group (49% TNFi group versus 77% non-TNFi group; p = 0.002). In regression models, switching to a non-TNFi was significantly associated with E-resp at m-24 (odds ratio = 3.21; p = 0.01). When assessing the response to the second biological agent based on the reason for discontinuation of the first TNFi, similar results were obtained; at m-24, patients who discontinued the first TNFi due to inefficacy (either primary or secondary) experienced a better E-resp if they had switched to a non-TNFi (primary inefficacy: 52% TNFi group versus 79% non-TNFi group, p = 0.09; secondary inefficacy: 50% versus 76%, p = 0.03). Conclusion: In our cohort of RA patients who discontinued a first TNFi, those who switched to a non-TNFi were three times more likely to attain a sustained clinical response, regardless of whether they had discontinued the first biologic due to a primary or secondary inefficacy.

The Role of Shared Epitope in Rheumatoid Arthritis Prognosis in Relation to Anti-Citrullinated Protein Antibody Positivity

“…Biological therapy has improved the prognoses of patients with RA; however, 30–40% of patients have an inadequate response to TNFis [ 28 ]. Bogas et al recently observed that after TNFi failure, regardless of whether primary or secondary inefficacy, a 24-month EULAR response was more frequently achieved after using a non-TNFi versus using a second TNFi [ 29 ]. A recent study on the role of SE in the effectiveness of TNFi treatment for patients with RA participating in the BRASS registry concluded that similar efficacy responses with TNFi therapies are seen regardless of SE status [ 30 ].…”

ACCP-negative rheumatoid arthritis – clinical and immunological features

“…Серонегативность по АЦЦП коррелировала с повышением риска развития инфекций на фоне лечения ТЦЗ [176]. Клинически и экономически более оправданным вариантом коррекции терапии при неэффективности иФНО-α является переход к ГИБП с альтернативным механизмом действия [177][178][179][180][181][182]. При сравнении РТМ и ТЦЗ их эффективность после потери эффекта иФНО-α была сопоставима [183].…”