Background Current recommendations for management of RA propose an 0anti-TNF agent for patients failing to achieve the treatment target with synthetic DMARDs. If 1st anti-TNF fails, a different anti-TNF, abatacept, rituximab (RTX) or tocilizumab (TCZ) are equally recommended.1 It has been shown that non anti-TNF agents are at least as effective as the anti-TNF. Little is known about the survival of 2nd biologic agents, especially RTX and TCZ.
Objectives To investigate the survival of the 2nd biologic after switching from the 1st anti-TNF agent.
Methods Data was extracted from the Slovenian registry (BioRx.si) on Dec 15th, 2012. Kaplan Meier survival analysis was performed. Statistical significance was determined with the Log-Rank and Wilcoxon tests.
Results 688 RA patients (81.5% female, mean age at diagnosis 45.2±11.8 years, 81.8% RF positive, 77% ACPA positive, concomitant methotrexate (MTX) 71.1%, leflunomide (LEF) 10.5%, metilprednisolone (MP) 45.3%, mean DAS28ESR 6.4±1.0) were treated using adalimumab, etanercept, infliximab, certolizumab, and golimumab in 43.6%, 30.7%, 10.7%, 9.9%, and 5.1% as the first biologic, respectively. Median survival of the first anti-TNF was 184 weeks. 242 (35.2%) patients (81.8% female, mean age at diagnosis 45.4±11.4 years, 81.8% RF positive, 77.6% ACPA positive; concomitant MTX 62.8%, LEF 12.4%, MP 47.1%; mean DAS28ESR 6.3±1.1) were switched to a different anti-TNF (55%), rituximab (14%) or tocilizumab (31%). Kaplan Meier survival curves for 2nd anti-TNF (as a group), RTX and TCZ are presented (Image). 2nd anti-TNF failed due to insufficient efficacy in 90%, and adverse events in 8%.
Conclusions After the 1st anti-TNF’s failure, a 2nd anti-TNF is more likely to fail earlier than RTX or TCZ (p=0.000). There is a trend of better survival of RTX vs TCZ, which did not reach statistical significance (p=0.057).
Smolen JS, et al. Ann Rheum Dis. 2010;69:964-75.
Disclosure of Interest None Declared
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