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FRI0163 Survival of the second biologic after the first anti-tnf failure in the treatment of rheumatoid arthritis: data from registry
  1. Ž. Rotar1,
  2. M. Tomšič1 on behalf of Slovenian Rheumatologists
  1. 1Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia


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 ( 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).


  1. Smolen JS, et al. Ann Rheum Dis. 2010;69:964-75.

Disclosure of Interest None Declared

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