Evaluating the efficacy of sequential biologic therapies for rheumatoid arthritis patients with an inadequate response to tumor necrosis factor-α inhibitors

Abstract

IntroductionThe long-term treatment of rheumatoid arthritis (RA) most often involves a sequence of different therapies. The response to therapy, disease progression and detailed knowledge of the role of different therapies along treatment pathways are key aspects to help physicians identify the best treatment strategy. Thus, understanding the effectiveness of different therapeutic sequences is of particular importance in the evaluation of long-term RA treatment strategies. The objective of this study was to systematically review and quantitatively evaluate the relationship between the clinical response to biologic treatments and the number of previous treatments with tumor necrosis factor α (TNF-α) inhibitors.MethodsA systematic search was undertaken to identify published, peer-reviewed articles that reported clinical outcomes of biologic treatment among RA patients with an inadequate response to TNF-α inhibitors. Data were systematically abstracted. Efficacy rates were estimated for groups of patients who differed in the number of prior TNF-α inhibitors used. End points included American College of Rheumatology (ACR)-, European League Against Rheumatism (EULAR)- and Disease Activity Score 28 (DAS28)-based response criteria.ResultsThe literature search identified 41 publications, of which 28 reported biologic treatment outcomes for RA patients with prior exposure to TNF-α inhibitors. Seven publications reported outcomes obtained in randomized clinical trials, while the remaining consisted of observational studies. The likelihood of responding to a subsequent biologic treatment decreased as the number of previous treatments with TNF-α inhibitors increased for six of the seven response criteria examined.ConclusionsFor patients with prior exposure to TNF-α inhibitors, the likelihood of response to subsequent treatment with biologic agents declines with the increasing number of previous treatments with TNF-α inhibitors.

Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry

“…Previous data indicate that patients with RA who fail their first biologic therapy experience worse efficacy on their second biologic [17][18][19][20]. Patients who are biologic-naïve experience better efficacy when they start a new biologic compared with patients who are biologic-experienced.…”

Clinical Pharmacokinetics and Pharmacodynamics of Monoclonal Antibodies Approved to Treat Rheumatoid Arthritis

“…These scores include ACR (American College of Rheumatology) [7] and DAS28 (Disease Activity Score in 28 joints) [8]. For instance, DAS28-based remission and low disease activity values (\2.6 and 3.2, respectively) allow the determination of lack of response (i.e., patients with no response achievement) or loss of response (i.e., patients with loss of response over time, referred to as secondary failures) [9].…”

Project: Recommendations on Treatment of Rheumatoid Arthritis Developed by All-Russian Public Organization «association of Rheumatologists of Russia» – 2014 (Part 1)

“…По данным РПКИ, РТМ, АБЦ, ТЦЗ и ГЛМ [217][218][219][220][221] эффективны у пациентов, резистент-ных к ингибиторам ФНОα; материалы открытых иссле-дований, национальных регистров и систематических обзоров свидетельствуют об эффективности замены од-ного ингибитора ФНОα на другой у пациентов, рези-стентных к первому ингибитору ФНОα, особенно при развитии вторичной неэффективности первого препара-та [222][223][224][225][226][227][228][229][230][231][232][233][234][235]; у пациентов, серопозитивных по ревмато-идному фактору (РФ) и/или антителам к циклическим цитруллинированным белкам (АЦБ), лечение РТМ бо-лее эффективно, чем замена одного ингибитора ФНОα на другой [236][237][238][239][240][241]; эффективность ТОФА у пациентов, резистентных к БПВП [240][241][242][243][244][245] и ингибиторам ФНОα [246], подтверждена материалами метаанализов [247][248][249].…”