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Differential drug retention between anti-TNF agents and alternative biological agents after inadequate response to an anti-TNF agent in rheumatoid arthritis patients
  1. Sophie Martin Du Pan1,
  2. Almut Scherer2,
  3. Cem Gabay1,
  4. Axel Finckh1
  1. 1Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
  2. 2SCQM Foundation, Zurich, Switzerland
  1. Correspondence to Sophie Martin Du Pan, University Hospitals of Geneva, Rheumatology, Geneva, Switzerland; Sophie.Martin-Du-Pan{at}


Background After inadequate response to an antitumour necrosis factor (aTNF) agent for treatment of rheumatoid arthritis (RA), rheumatologists can choose an alternative aTNF or a biological agent with another mode of action (non-aTNF biological (non-aTNF-Bio)).

Objective To compare drug retention rates of non-aTNF-Bio with alternative aTNF.

Methods All patients within the Swiss RA cohort (SCQM-RA) treated with an alternative biotherapy after a prior inadequate response to aTNF were analysed. The drug retention of alternative aTNF was compared with non-aTNF-Bio using Cox proportional hazards models, adjusted for potential confounders.

Results 1485 treatment courses after aTNF failure were available for analysis, 853 with alternative aTNF and 632 with non-aTNF-Bio. The median drug retention was 32 months (IQR 14–54) on non-aTNF-Bio versus 21 months (IQR 8–53) on alternative aTNF, or a 50% reduction drug discontinuation risk in favour of non-aTNF-Bio (adjusted hazard ratio (HR) for non-aTNF-Bio: 0.50 (95% CI 0.41 to 0.62)). This effect appears to be modified by the type of prior aTNF failure, with a larger difference in favour of non-aTNF-Bio in patients having experienced a primary failure with a previous aTNF (HR: 0.33 (95% CI 0.24 to 0.47), p<0.001).

Conclusion After inadequate response to aTNF, and particularly after primary failure, patients on a non-aTNF-Bio agent have significantly higher drug retention rates.

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  • Funding Rheumasearch Foundation Switzerland.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. The layout of “Table 1” has been amended and extra text has been added to the footnotes of the table.

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