Switching TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: an observational study over a five-year period

Fabrizio Conti ¹, Fulvia Ceccarelli ¹, Elisa Marocchi ¹, Leonardo Magrini ¹, Francesca Romana Spinelli ¹, Antonio Spadaro ¹, Rossana Scrivo ¹ and Guido Valesini ^1*

¹ Sapienza Università di Roma, Italy

^* To whom correspondence should be addressed. E-mail: guido.valesini{at}uniroma1.it.

Accepted 28 June 2007

Abstract

Objective: To evaluate the clinical response after switching from one TNF antagonist to another in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Methods: In this ongoing, longitudinal, observational study we have prospectively collected data on efficacy and safety for patients starting biological treatments since 2000. The present analysis is restricted to patients with a diagnosis of spondyloarthritis (SpA) who switched from one TNF antagonist to another due to inadequate efficacy or adverse events.

Results: A total of 589 anti-TNF-naive patients has been registered, of whom 165 with a diagnosis of SpA. Seven AS patients and 15 with PsA received more than one TNF antagonist. Two PsA patients were treated with all the drugs. Sixteen subjects switched from infliximab to etanercept, 7 patients switched from etanercept to adalimumab, 1 patient switched from etanercept to infliximab. Overall, a clinical response was demonstrated in 75% who changed from infliximab to etanercept, and in 57.1% who switched from etanercept to adalimumab.

Conclusions: The findings of this study on a selected population of SpA patients indicate that the failure of a first TNF antagonist does not preclude the response to another one. Further trials are needed to confirm this preliminary obsevartion.

Keywords: TNF[alpha] antagonists, ankylosing spondylitis, psoriatic arthritis, spondyloarthropathy, switching

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