Background The strategy for the choice of the second biologic agent after the failure of the first TNF inhibitor (TNFi) is still an unclear aspect in the treatment of both rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Switching between structurally different TNFis (from etanercept [ETN] to monoclonal antibody [mAb] or vice versa) has been proposed as a more effective procedure than switching among different mAbs, but to date no study has been specifically focused on exploring this topic.
Objectives To evaluate the comparative 2-year retention rate and the 12-month efficacy of adalimumab (ADA) as second biologic agent in etanercept (ETN) non-responder RA and PsA patients in a multicentre retrospective study.
Methods All RA and PsA patients from 11 Italian Rheumatology Units treated with ADA after a first-course ETN failure and with at least 12-month follow-up were retrospectively collected in a multicentre registry. Data analysis was limited to the period from January 2002 to May 2016. Two-year ADA retention rate was calculated by Kaplan-Meier method. 12-month ADA response was defined as achievement of disease activity score 28 calculated by using erythrosedimentation (DAS28-ESR) <2.6 (remission) or >2.6 and <3.2 (low disease activity, LDA). Sub-analyses according to reason for ETN discontinuation and concomitant methotrexate in RA and PsA patients have been performed.
Results The study population (219 patients) included 117 RA (female 85.5%, mean [± standard deviation, SD] age 53.2±13.5 years, mean [±SD] disease duration 10.1±7.7; positive rheumatoid factor 70.2%; positive anti-citrullinated peptide antibodies [ACPA] 59.6%; mean [±SD] baseline DAS28-ESR 4.97±1.3; MTX users 64.9%) and 102 PsA (female 63.7%; mean [±SD] age 51.7±10.6; mean [±SD] disease duration 7.1±5.1; mean [±SD] baseline DAS28-ESR 4.4±1.1; MTX users 50%). The 2-year retention rate was 48.2% in RA and 56.5% in PsA patients, irrespective of reason for ETN discontinuation. Similarly, concomitant MTX was not associated with an increased drug survival in both RA (p=0.09) and PsA (p=0.969) subgroup. 12-month clinical remission and LDA were achieved respectively in 27.3% and 23.9% RA patients, and 27.4% and 23.5% PsA patients.
Conclusions In our large real-life cohort, the use of ADA in primary and secondary ETN failures was highly effective in both RA and PsA patients, with more than 50% of ADA treated patients achieving remission or LDA. Reasons for ETN discontinuation were not associated with different ADA clinical response, as well as concomitant MTX.
Disclosure of Interest None declared