Background The treatment of RA has improved significantly over the past decade with the introduction of highly effective tumor necrosis factor inhibitors (TNFi). However, these drugs have little or no effect in about 30% of treated patients. In these cases, the disease-modifying antirheumatic drugs (DMARDs) must be switched. According to the European League Against Rheumatism recommendations, patients who do not respond to initial TNFi therapy should switch to a different TNFi or use a different class of biological DMARD (abatacept, rituximab or tocilizumab) . While several studies have reported on switching from TNFi to other biologics [2, 3], no consensus exists on which drug should be chosen.
Objectives The aim of this study was to compare the efficacy and retention rates of three biologics (abatacept, tocilizumab and etanercept) after switching from first-course anti-TNF monoclonal antibody therapy.
Methods We performed a retrospective multicenter study of 89 patients who underwent second-course biologic therapy for 52 weeks after switching from first-course anti-TNF monoclonal antibody therapy in the Tsurumai Biologic Communication Registry (TBCR). Patients were divided into three groups based on the biologic they switched to: abatacept (n=25), tocilizumab (n=38) and etanercept (n=26). Changes in clinical parameters were examined at 0, 24, and 52 weeks after the switch. Disease activity was evaluated at each time point using the DAS28-CRP, as well as the CDAI, which included data from the above-mentioned disease parameters.
Results Patients at baseline had a mean age of 58.7 years, mean disease duration of 9.8 years, and mean clinical disease activity index (CDAI) of 22.4. There was no significant difference between the three drugs, except in rheumatoid factor positivity. Retention rates for abatacept, tocilizumab and etanercept at 52 weeks were 72.0%, 89.5% and 84.6%, respectively (Fig. 1). The evaluation of CDAI indicated no significant difference at 52 weeks among the three drugs (Fig. 2). Discontinuation due to all unfavorable causes did not significantly differ among the three drugs in hazard ratio-based evaluations (Table 1).
Conclusions This study is the first to compare the clinical efficacy of three different classes of biological DMARDs (abatacept, tocilizumab and etanercept) after the first-line anti-TNF agent using a multicenter registry system. Patients treated with abatacept, tocilizumab and etanercept achieved a high response rate with no significant differences in drug retention rates and clinical efficacy. These drugs offer good therapeutic options in patients with inadequate response to anti-TNF monoclonal antibodies.
Smolen JS, et al. Annals of the Rheumatic Diseases 2010;69:964-75.
Leffers HC, et al. Annals of the Rheumatic Diseases 2011;70:1216-22.
Hjardem E, et al. Annals of the Rheumatic Diseases 2007;66:1184-9.
Disclosure of Interest None declared