Managing inadequate response to initial anti-TNF therapy in rheumatoid arthritis: optimising treatment outcomes

Taylor, Peter C; Matucci‐Cerinic, Marco; Alten, Rieke; Avouac, Jérôme; Westhovens, René

doi:10.1177/1759720x221114101

Cited by 11 publications

(9 citation statements)

References 78 publications

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“…В этом случае важно сохранить ремиссию, достигнутую с помощью исходного препарата, и избежать развития НЯ. Показано, что перевод на другой препарат внутри внутри класса иФНО-α дает дополнительный эффект, и наибольшая эффективность наблюдается при назначении отличного по структуре ГИБП [24,28]. Однако каждое последующее их переключение сопровождается значительным снижением эффективности терапии [24].…”

Section: Discussionunclassified

“…Одной из основных задач ведения больных РА является тщательный контроль активности болезни [24]. Так, по данным T.W.…”

Section: Discussionunclassified

“…Известно, что наиболее частыми причинами прекращения или переключения терапии ГИБП являются первичная или вторичная неэффективность, а также связанные с препаратом НЯ [9,10]. Вместе с тем отсутствие строгих руководящих принципов, основанных на реальных данных, приводит к тому, что модели назначения ГИБП варьируют во всем мире; нередко основанием для выбора конкретного препарата становятся предпочтения врачей и пациентов, а также доступность и нормативная политика, которая во многом определяется значительной стоимостью ГИБП для системы здравоохранения [24,25,28].…”

Section: анализ безопасностиunclassified

“…Они могут включать возраст пациентов РА, их индивидуальные особенности, когнитивный статус, образ жизни, род занятий, частоту и способ введения лекарства. Экономическая эффективность и недостаточная доступность ГИБП в связи с повышенной нагрузкой на систему здравоохранения при возникновении чрезвычайных обстоятельств (пандемия) также рассматриваются в качестве возможных причин административных переключений [24,25]. Они особенно часто проводились в период пандемии COVID-19 в рамках иИЛ-6Р [26].…”

Section: Introductionunclassified

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Management of patients with rheumatoid arthritis in real clinical practice: Switching from interleukin 6 receptor inhibitors to interleukin 6 inhibitor (olokizumab)

Baranov,

Vinogradova,

Anoshenkova

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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Aim. Switching to another biologic with the same mode of action provides greater opportunity for long-term management of patients with rheumatoid arthritis (RA). In clinical practice, especially in the context of the COVID-19 pandemic, such switching occurred for non-medical reasons as well. However, there is no information about switching from interleukin 6 (IL-6) receptor (R) inhibitor to direct IL-6 inhibitor. Objective – to assess the efficacy and safety of therapy in RA patients, after switching from IL-6R inhibitors (tocilizumab (TOC), sarilumab (SAR)) to olokizumab (OKZ) for reasons not related to the loss of their efficacy or adverse events. Material and methods. In this retrospective cohort study efficacy parameters and routine biochemical data were analyzed using descriptive statistics – mean values with standard deviation for continuous parameters and absolute and relative frequency for binary variables. Adverse events (AE) were reported according to patient’s files. The statistical significance and changes of the analyzed variables by visits were determined using paired t-test. Fisher’s exact test or chi-square test was used to compare the proportion of patients with improvement/no change and of patients with worsening. All tests were 2-sided, and p<0.050 was considered statistically significant. As this was an observational study, the statistical criteria have not been pre-specified. Results. We analyzed results obtained during 5 visits (2 visits before switching, switching visit and 2 visits after switching) in 110 RA patients who switched to OKZ 64 mg every 4 weeks subcutaneously (SC). Most patients (79.1%) were women, and 70% of patients were both positive by rheumatoid factor and antibodies to cyclic citrullinated peptide. Mean RA duration was 11 [6; 16] years, previous treatment duration was 44 [27; 62] months and mean interval before switching to OKZ was 35 [31; 68] days. This relatively long interval led to an increase in DAS28-ESR (Disease Activity Score 28 with determination of erythrocyte sedimentation rate) from 2.4 [1.9; 3.0] to 2.6 [2.1; 3.5] and DAS28-CRP (DAS28 with determination of C-reactive protein level) from 2.8 [2.0; 3.3] to 2.9 [2.2; 4.0] (the trends were similar in patients who received combined therapy and monotherapy). After switching, all of RA symptoms and indexes have been improved compared with the switching visit (some of them were significantly better even compared with stable therapy period e. g. DAS28-CRP was 2.4 [2.0; 3.1] in the overall group and 2.4 [2.1; 2.7] in the monotherapy group). AEs were registered in only 7 (6.4%) patients, of which 1 (0.9%) case (an exacerbation of herpes infection) was considered as serious. The most frequent AEs were arthralgia and mild transient leukopenia (2 patients each). There were no deaths. Conclusion. OKZ effectively maintained remission/low activity of RA after switching in both regimens: as add-on to disease modifying anti-rheumatic drugs and as monotherapy, and did not cause any additional safety concerns. The optimal results were reported when intervals before switching to OKZ were closer to those indicated in the instructions for IL-6R inhibitors.

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Section: Discussionunclassified

Section: анализ безопасностиunclassified

Section: Introductionunclassified

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Management of patients with rheumatoid arthritis in real clinical practice: Switching from interleukin 6 receptor inhibitors to interleukin 6 inhibitor (olokizumab)

Baranov,

Vinogradova,

Anoshenkova

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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“…The presence of co-morbidities may also be an important consideration in determining the patients who stand to benefit most from the new eligibility for biologic therapies recommended in NICE TA715. Since anti-TNFs such as adalimumab, etanercept and infliximab are known to reduce cardiovascular co-morbidity [25][26][27][28], they may represent a treatment of choice in patients with moderately active RA with early or established cardiovascular disease, but without advanced stage heart failure [29]. In the case of overweight patients, a high body mass index can be accompanied by an increase in acute phase markers and in DAS28 score; therefore, referral to a 12-week gym programme and signposting healthy eating websites may be a more desirable first step as opposed to moving straight to biologics.…”

Section: Identification Of Candidate Patientsmentioning

confidence: 99%

Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease

Taylor

Askari

Choy

et al. 2023

BMC Med

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Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with joint pain and stiffness. Biologics represent some of the most effective treatments for RA, but previous guidance from the National Institute for Health and Care Excellence (NICE) has limited their use to patients with severely active disease. This has meant patients with moderately active RA have been treated as if they have an acceptable disease state, despite many cases where the inflammation has a major impact on joint damage, mobility, pain and quality of life. However, recent guideline changes (NICE TA715) have approved the use of three biologics — adalimumab, etanercept and infliximab — for the treatment of moderately active RA. Main body In response to these changes, we have held discussions with medical teams from across the UK to consider the main implications for implementation of these new recommendations, as well as any differences in approach that may exist at a local level. Several key challenges were identified. These included establishing methods of educating both physicians and patients concerning the new availability of the biologic treatments, with suggestions of various organisations that could be approached to circulate informative material. Identifying which patients with moderately active RA stand to benefit was another discussion topic. Relying solely on scoring systems like Disease Activity Score in 28 Joints (DAS28) was acknowledged to have limitations, and alternative complementary approaches such as ultrasound, as well as assessing a patient’s co-morbidities, could also be useful tools in determining those who could benefit from biologics. An additional challenge for the process of patient identification has been the increase in the use of telemedicine consultations in response to the coronavirus disease 2019 (COVID-19) pandemic. More use of patient-reported outcomes was raised as one possible solution, and the importance of maintaining up-to-date databases on patient disease scores and treatment history was also stressed. Conclusion While challenges exist in education and identifying patients who may benefit from the use of biologics, the NICE TA715 recommendations hold great potential in addressing an unmet need for the treatment of moderate RA.

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A Real-World Comparison of Clinical Effectiveness in Patients with Rheumatoid Arthritis Treated with Upadacitinib, Tumor Necrosis Factor Inhibitors, and Other Advanced Therapies After Switching from an Initial Tumor Necrosis Factor Inhibitor

Caporali,

Kadakia,

Howell

et al. 2024

Adv Ther

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Introduction This study compared the clinical effectiveness of switching from tumor necrosis factor inhibitor (TNFi) to upadacitinib (TNFi-UPA), another TNFi (TNFi-TNFi), or an advanced therapy with another mechanism of action (TNFi-other MOA) in patients with rheumatoid arthritis (RA). Methods Data were drawn from the Adelphi RA Disease Specific Programme™, a cross-sectional survey administered to rheumatologists and their consulting patients in Germany, France, Italy, Spain, the UK, Japan, Canada, and the USA from May 2021 to January 2022. Patients who switched treatment from an initial TNFi were stratified by subsequent therapy of interest: TNFi-UPA, TNFi-TNFi, or TNFi-other MOA. Physician-reported clinical outcomes including disease activity (with formal DAS28 scoring available for 29% of patients) categorized as remission, low/moderate/high disease activity, as well as pain were recorded at initiation of current treatment and ≥ 6 months from treatment switch. Fatigue and treatment adherence were measured ≥ 6 months from treatment switch. Inverse-probability-weighted regression adjustment compared outcomes by subsequent class of therapy: TNFi-UPA versus TNFi-TNFi, or TNFi-UPA versus TNFi-other MOA. Results Of 503 patients who switched from their first TNFi, 261 were in TNFi-UPA, 128 in TNFi-TNFi, and 114 in TNFi-other MOA groups. At the time of switch, most patients had moderate/high disease activity (TNFi-UPA: 73%; TNFi-TNFi: 52%; TNFi-other MOA: 60%). After adjustment for differences in characteristics at point of switch, patients in TNFi-UPA group ( n = 261) were significantly more likely to achieve physician-reported remission (67.7% vs. 40.3%; p = 0.0015), no pain (55.7% vs. 25.4%; p = 0.0007), and complete adherence (60.0% vs. 34.2%; p = 0.0049) compared with patients in TNFi-TNFi group ( n = 121). Similar findings were observed for TNFi-UPA versus TNFi-other MOA groups ( n = 111). Conclusion Patients who switched from TNFi to UPA had significantly better clinical outcomes of remission, no pain, and complete adherence than those who cycled TNFi or switched to another MOA. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-024-02948-0.

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Managing inadequate response to initial anti-TNF therapy in rheumatoid arthritis: optimising treatment outcomes

Cited by 11 publications

References 78 publications

Management of patients with rheumatoid arthritis in real clinical practice: Switching from interleukin 6 receptor inhibitors to interleukin 6 inhibitor (olokizumab)

Management of patients with rheumatoid arthritis in real clinical practice: Switching from interleukin 6 receptor inhibitors to interleukin 6 inhibitor (olokizumab)

Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease

A Real-World Comparison of Clinical Effectiveness in Patients with Rheumatoid Arthritis Treated with Upadacitinib, Tumor Necrosis Factor Inhibitors, and Other Advanced Therapies After Switching from an Initial Tumor Necrosis Factor Inhibitor

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