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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 Hjardem1,
  2. Mikkel Østergaard2,
  3. Jan Pødenphant3,
  4. Ulrik Tarp4,
  5. Lis Smedegaard Andersen5,
  6. Jette Bing6,
  7. Elisabeth Peen7,
  8. Hanne Merete Lindegaard8,
  9. Vibeke Stevenius Ringsdal9,
  10. Anne Rødgaard10,
  11. Jens Skøt11,
  12. Annette Hansen12,
  13. Hans Henrik Mogensen13,
  14. Janne Unkerskov14,
  15. Merete Lund Hetland2
  1. 1Department of Rheumatology, Copenhagen University Hospital, Hvidovre, Denmark
  2. 2The Danish Database for Biological Therapies in Rheumatology (DANBIO), Hvidovre, Denmark
  3. 3Copenhagen University Hospital, Herlev, Denmark
  4. 4Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  5. 5Rheumatism Hospital, University of Southern Denmark, Odense, Denmark
  6. 6Department of Rheumatology, Copenhagen University Hospital, Frederiksberg, Denmark
  7. 7Department of Rheumatology, Sydvestjysk Sygehus, Esbjerg, Denmark
  8. 8Department of Internal Medicine, Section of Rheumatology, University Hospital, Odense, Denmark
  9. 9Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
  10. 10Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
  11. 11Department of Rheumatology, Copenhagen University Hospital, Gentofte, Denmark
  12. 12Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  13. 13Department of Rheumatology, Hoersholm Hospital, Hoersholm, Denmark
  14. 14Institute for Rational Pharmacotherapy, Danish Medicines Agency, Copenhagen, Denmark
  1. Correspondence to:
    Dr Merete Lund Hetland
    Copenhagen University Hospital at Hvidovre, Department of Rheumatology 232, Kettegård Alle 30, DK 2650 Hvidovre, Denmark; merete.hetland{at}


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

Methods: Since 2000, Danish RA patients (n  =  1021) receiving biological therapy have been registered in the nationwide DANBIO database. The first and second treatment series of patients, who switched therapy before 2005 (n  =  235), were analysed for their reasons for switching, Disease Activity Score 28 (DAS28), DAS28 improvement, European League against Rheumatology (EULAR) response and drug survival. Most patients switched from infliximab to etanercept or adalimumab.

Results: Median survivals for switchers’ first/second treatment were 37/92 weeks (all patients’ first 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 first drug, 15% had AE to the second. Median DAS28 improvements in first/second 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 second treatment course than during the first (63% versus 54%, p  =  0.02). AE switchers achieved similar EULAR responses to both treatments (59% versus 50%, p  =  0.38).

Conclusion: LOE switchers had a better clinical response to the second treatment. AE switchers responded equally well to both treatments, with a low risk of discontinuing the second drug as a result of AE. Drug survival of the switchers’ second biological therapy was higher than of the first, 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.

  • AE, Adverse event
  • DAS28, Disease Activity Score 28
  • DMARD, disease-modifying antirheumatic drug
  • EULAR, European League against Rheumatology
  • LOE, lack of efficacy
  • RA, rheumatoid arthritis
  • TNFα, tumor necrosis factor alpha

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  • Published Online First 27 March 2007

  • Competing interests: None.