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Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study
  1. Karen Minde Fagerli1,
  2. Elisabeth Lie1,
  3. Désirée van der Heijde1,2,
  4. Marte Schrumpf Heiberg1,
  5. Synøve Kalstad3,
  6. Erik Rødevand4,
  7. Knut Mikkelsen5,
  8. Åse Stavland Lexberg6,
  9. Tore K Kvien1
  1. 1Deprtment of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Rheumatology, University Hospital of Northern Norway, Norway
  4. 4Depatment of Rheumatology, St Olavs Hospital, Norway
  5. 5Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
  6. 6Department of Rheumatology, Vestre Viken/Drammen Hospital, Drammen, Norway
  1. Correspondence to Dr Karen Minde Fagerli, Deprtment of Rheumatology, Diakonhjemmet Hospital, P.b. 23, Vinderen, Oslo 0319, Norway; karen.fagerli{at}


Background Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients do not respond or do not tolerate their first TNFi, and are switched to a different TNFi. Evidence supporting this practice is limited, and we wanted to investigate the effectiveness of switching to a second TNFi.

Material and methods From a longitudinal observational study (LOS) we selected patients with PsA who were starting their first TNFi, and identified patients who had switched to a second TNFi (‘switchers’). Three-month responses and 3-year drug-survival were compared between switchers and non-switchers, and within switchers.

Results Switchers (n=95) receiving their second TNFi had significantly poorer responses compared with non-switchers (n=344) (ACR50 response: 22.5% vs 40.0%, DAS28 remission: 28.2% vs 54.1%). There was a trend towards poorer responses to the second TNFi compared with the first TNFi within switchers. Estimated 3-year drug-survival was 36% for the second TNFi compared with 57% for the first TNFi overall.

Conclusions 20–40% of patients had a response on a second TNFi after having failed one TNFi in this LOS. This observation highlights the need for treatments with other mechanisms of action than TNF inhibition in patients with PsA.

  • Anti-TNF
  • Psoriatic Arthritis
  • Treatment

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