Background Since the approval of infliximab (IFX) in 2003, 8 biologics have been approved for rheumatoid arthritis (RA) in Japan. However, little is known regarding what to do when patients have an inadequate response to first biologics in daily clinical practice.

Objectives This study aimed to evaluate the effectiveness of biologics as 2nd-line use in RA patients in daily clinical practice from our university cohort (FIRST registry).

Methods We retrospectively examined 2553 patients who were treated with biologics in our institute between July 2003 and December 2015. We compared the effectiveness of TNF-inhibitors (TNFi), TCZ, ABA as 2nd-line use and efficacy of switching from 1st TNFi to 2nd TNFi, TCZ or ABA based on retention rates and change in disease activity such as CDAI at 1 year, ΔCDAI (0–52W), ΔDAS28-ESR (LOCF). Propensity score (PS) were generated using multinomial logistic regression and the study groups were matched regarding baseline variables including age, disease duration, disease activity, concomitant use of MTX and PSL. In addition, in order to find out the characteristic of 2nd biologics, we conducted comparison between the upper (1yCDAI-H; low response) and lower (1yCDAI-L; good response) quartiles in CDAI at 1 y after switching.

Results In terms of switching of biologics, better treatment outcome of ΔCDAI was observed in order of TCZ (n=141) >2nd TNFi (n=186) >ABT (n=91) but was comparable after the adjustment by PS. Comparison between the upper (1yCDAI-H) and lower (1yCDAI-L) quartiles in CDAI at 1 y after switching revealed that disease activity might improve despite of a high disease activity at switching in the case of TCZ as shown in Figure. In addition, high CRP and MMP-3 at switching were higher in the 1y CDAI-L group only in the case of switching to TCZ.

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Figure 1.

Comparison of DAS28, CRP and MMP3 at initiation of 2nd biologics between the upper (1yCDAI-H) and lower (1yCDAI-L) quartiles in CDAI at 1 y after switching.

Conclusions After adjustment using PS-score, RA patients with prior anti-TNF exposures had similar outcomes if they switched to a new TNFi as compared with initiation of TCZ or ABA. Also our results imply us that TCZ might bring about good outcome despite of disease activity at switching. Furthermore, higher CRP or MMP-3, suggesting inadequate suppression of IL-6 by first biologics, might predict better outcome of TCZ.

Disclosure of Interest K. Saito: None declared, K. Nakano: None declared, S. Nakayamada: None declared, S. Kubo: None declared, I. Miyagawa: None declared, S. Hirata Speakers bureau: AbbVie, Eisai, Bristol Meyers Squibb, Y. Tanaka Grant/research support from: Mitsubishi-Tanabe, Chugai, MSD, Speakers bureau: Abbvie, Chugai, Astellas, Takeda, Santen, Mitsubishi-Tanabe, Pfizer, Janssen,