Background There are few studies evaluating switching strategies of biological therapy in RA1. Survival studies are indirect evidence of treatment efficacy and safety besides being an useful tool to evaluate switching options in the real life2.
Objectives To compare the survival of different strategies of switching to a second biological therapy.
Methods Data from a population-based cohort including 1,109 RA patients biological therapy were analyzed at baseline (beginning of the first biologic therapy) up to 7 years (2009–2015). Sex, age, disease duration, DAS-28 and concomitant treatments at baseline were recorded. Kaplan-Meier estimates, Chi-square, Kruskal-Wallis and Wilcoxon-Mann-Whitney tests, Cox regression analysis were applied when appropriate. Results expressed in mean±SD, % (n). Small sample precluded golimumab (GOL) and certolizumab (CER) from the survival analysis.
Results 85% of the patients were women; mean age=50.10±11.81yrs; 86,56% rheumatoid factor positive. At baseline, mean DAS28=5.36±1.35; 77% receiving methotrexate, 78% prednisone, and 40% leflunomide. Regarding biological therapy, 32.1% (356) started with infliximab (INF), 33.36% (370) with adalimumab (ADA), 23.26% (258) with etanercept (ETA), 4.33% (48) with rituximab (RTX), 3.15% (35) with tocilizumab (TOC), 1.26% (14) with abatacept (ABA), 1.70% (19) with GOL and 0.81% (09) with CER. 32.28% (358) switched to second biological therapy. Of those, 65.92% (236) switched from anti-TNF to anti-TNF (INF=33, ETA=105, ADA=83) vs 27.93% (100) from anti-TNF to non anti-TNF (RTX=38, TOC=32, ABA=30), 6.13% from non anti TNF to anti-TNF (n=15) or to non anti-TNF (n=7). Discontinuation of first anti-TNF therapy was due to inefficacy (57%, n=134), adverse effects (31%, n=73) or other (12%, n=29). Better switching strategy was from anti-TNF to non-anti-TNF: 50.72±3.00 (95%CI 44.84,56.60) vs 44.67± 2.46,(95%CI 39.85,49.49)months; p=0.010. Patients that switched to TOC were using less corticosteroid, had higher DAS28 at baseline, and yield better survival (55.80±4.74 95%CI 46.51,65.09 months, p=0.029) as second biological therapy compared to ETA (50.06±3.61 95%CI 42.99–57.14), RIT (47.75±4.93 95%CI 38.10,57.40), ABA (44.89±5.94 95%CI 33.25,56.53), ADA (39.45±3.89 95%CI 31.83,47.08), and INF (34.43±4.65 95%CI 25.31,43.55).
Conclusions Switching from anti-TNF to non anti-TNF therapy seems to be a better option in the treatment of RA patients. Tocilizumab showed a better survival as second biological therapy, especially in severe disease.
Emery P, et al. Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previus TNF inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study. Ann Rheum Dis 2015;74:979–984.
Chatzzidionysiou K, et al. Effectiveness of TNF inhibitor switch in RA: results from the national Swedish register. Ann Rheum Dis 2015;74:890–896.
Disclosure of Interest None declared