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Do rheumatoid arthritis patients in clinical practice benefit from switching from infliximab to a second tumor necrosis factor alpha inhibitor?
  1. Elisabeth Hjardem (fillebille{at}
  1. Hvidovre Hospital, Denmark
    1. Mikkel Østergaard (mo{at}
    1. The Danish Database for Biological Therapies in Rheumatology (Danbio), Denmark
      1. Jan Pødenphant (japd{at}
      1. Copenhagen University Hospital at Herlev, Denmark
        1. Ulrik Tarp (utarp{at}
        1. University Hospital at Aarhus, Denmark
          1. Lis Smedegaard Andersen (lsandersen{at}
          1. Rheumatism Hospital, Gråsten, Denmark
            1. Jette Bing ({at}
            1. Copenhagen University Hospital at Frederiksberg, Denmark
              1. Elisabeth Peen (elpe{at}
              1. Sydvestjysk Sygehus in Esbjerg, Denmark
                1. Hanne Merete Lindegaard (lindegaard{at}
                1. University Hospital at Odense, Denmark
                  1. Vibeke Stevenius Ringsdal (skovbakkevej{at}
                  1. Aalborg University Hospital, Denmark
                    1. Anne Rødgaard (anroan01{at}
                    1. University Hosptial in Glostrup, Denmark
                      1. Jens Skøt (jens.skoet{at}
                      1. University Hospital at Gentofte, Denmark
                        1. Annette Hansen (d263249{at}
                        1. University Hospital of Rigshospitalet, Denmark
                          1. Hans Henrik Mogensen (hahemo{at}
                          1. Hørsholm Hospital, Denmark
                            1. Janne Unkerskov (unkerskov{at}
                            1. Institute for Rational Pharmacotherapy, Danish Medicines Agency, Denmark
                              1. Merete Lund Hetland (merete.hetland{at}
                              1. University Hospital at Hvidovre, Denmark


                                Objective:In rheumatoid arthritis (RA) patients to investigate the efficacy of switching to a second biological drug.

                                Methods:Since 2000, Danish RA patients (n=1021) receiving biological therapy have been registered in the nationwide DANBIO database. The 1st and 2nd treatment series of patients, who switched therapy before 2005 (n=235), were analysed for reasons for switching, DAS28 score, DAS28 improvement, EULAR response and drug survival. Most patients switched from infliximab to etanercept or adalimumab.

                                Results:Median survivals for switchers' 1st /2nd treatment were 37/92 weeks (All patients’ 1st treatment: 119 weeks). Reasons for switching were lack of efficacy (LOE) (109 patients), adverse events (AE) (72), other reasons (54). If patients experienced AE to the 1st drug, 15% had AE to the 2nd. Median DAS28 improvements in 1st /2nd treatment at 3 months were: LOE switchers: 1.1/1.6; AE switchers: 1.5/0.8. In LOE switchers, a good/moderate EULAR response was more prevalent during the 2nd treatment course than during the 1st (63% vs. 54%, p=0.02). AE switchers achieved similar EULAR responses to both treatments (59% vs. 50%, p=0.38).

                                ConclusionLOE switchers had better clinical response to the 2nd treatment. AE switchers responded equally well to both treatments with a low risk of discontinuing the 2nd drug due to AE. Drug survival of the switchers’ 2nd biological therapy was higher than of the 1st, but lower than that of non-switchers. No difference between various sequences of drugs were found. Danish post-marketing data thus support that RA patients may benefit from switching biological therapy.

                                • TNF alpha inhibitors
                                • drug efficacy
                                • observational study
                                • rheumatoid arthritis
                                • second biological treatment

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