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Switching tumour necrosis factor α antagonists in patients with ankylosing spondylitis and psoriatic arthritis: an observational study over a 5-year period
  1. Fabrizio Conti,
  2. Fulvia Ceccarelli,
  3. Elisa Marocchi,
  4. Leonardo Magrini,
  5. Francesca Romana Spinelli,
  6. Antonio Spadaro,
  7. Rossana Scrivo,
  8. Guido Valesini
  1. Dipartimento di Clinica e Terapia Medica, Sezione di Reumatologia, Sapienza Università di Roma, Policlinico Umberto I, Roma, Italy
  1. Professor Guido Valesini, Dipartimento di Clinica e Terapia Medica, Sezione di Reumatologia, Sapienza Università di Roma, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; guido.valesini{at}


Objective: To evaluate the clinical response after switching from one tumour necrosis factor (TNF)α antagonist to another in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Methods: In this ongoing, longitudinal, observational study, data were prospectively collected on efficacy and safety since 2000 for patients starting biological treatments. The present analysis was restricted to patients with a diagnosis of spondyloarthropathy (SpA) who switched from one TNFα antagonist to another because of inadequate efficacy or adverse events.

Results: In total, 589 anti-TNFα-naive patients were registered, of whom 165 had a diagnosis of SpA; 7 patients with AS and 15 with PsA received >1 TNFα antagonist. Two patients with PsA were treated with all the drugs. In all, 16 subjects switched from infliximab to etanercept, 7 from etanercept to adalimumab and 1 from etanercept to infliximab. Overall, a clinical response was seen in 75% of patients who changed from infliximab to etanercept, and in 57.1% who switched from etanercept to adalimumab.

Conclusions: The findings of this study on a selected population of patients with SpA indicate that the failure of an initial TNFα antagonist does not preclude the response to another one. Further trials are needed to confirm this preliminary observation.

  • spondyloarthropathy
  • ankylosing spondylitis
  • psoriatic arthritis
  • TNFα antagonists
  • switching

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  • Competing interests: None declared.

  • Abbreviations:
    adverse events
    ankylosing spondylitis
    ASsessment in Ankylosing Spondylitis
    Bath Ankylosing Spondylitis Disease Activity Index
    Health Assessment Questionnaire
    psoriatic arthritis
    Psoriatic Arthritis Response Criteria
    rheumatoid arthritis
    tumour necrosis factor
    visual analogue scale