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FRI0236 After discontinuation of the 1st tumor necrosis factor inhibitor (TNFI), non-tnfi biologic agents have similar responses but higher survival compared to a 2nd course of a different tnfi: long-term prospective observational study of patients with rheumatoid arthritis in a tertiary hospital of greece
  1. ID Flouri1,
  2. A Repa1,
  3. N Avgoustidis1,
  4. N Kougas1,
  5. A Fanouriakis1,
  6. I Papalopoulos1,
  7. C Adamichou1,
  8. P Kyfonidou1,
  9. E Kampouraki1,
  10. M Terizaki1,
  11. DT Boumpas2,
  12. G Bertsias1,
  13. P Sidiropoulos1
  1. 1Rheumatology, Clinical Immunology and Allergy, Faculty of Medicine-University of Crete, Heraklion, Crete
  2. 24th Internal Medicine Department, Attikon University Hospital, Athens, Greece


Background For rheumatoid arthritis (RA) patients who discontinue the first biologic agent (bDMARD), most commonly being a TNF inhibitor (TNFi), there is little evidence supporting the next best choice between a second TNFi course or a non-TNFi bDMARD in clinical practice.

Objectives To compare the effectiveness and the adherence to therapy with non-TNFi versus TNFi administered as the second-line bDMARD in RA patients with one prior TNFi use.

Methods All patients starting a bDMARD in the Rheumatology Department of the University Hospital of Heraklion, Crete, are included in a prospective observational study after their written informed consent. Data concerning disease activity at pre-specified time-points, drugs, comorbidities and any adverse events are recorded. For the present study we analyzed patients with RA starting their second course of a bDMARD after discontinuation of a TNFi. We compared DAS28 difference at 6 and 12 months using linear regression analysis and treatment retention using Kaplan-Meier survival curves with log-rank test.

Results A total of 384 patients started a 2nd (different) TNFi [N=213 (Infliximab: 26, Adalimumab: 77, Etanercept: 89, Golimumab: 13 and Certolizumab: 8)] or a non-TNFi [N=171 (Rituximab:71, Abatacept:66, Tocilizumab:34)]. Patients' characteristics at baseline are described in the Table.

Two-year drug survival was higher for non-TNFi (64% vs. 39%, log rank p<0.001) due to lower frequency of discontinuations for primary failure (p<0.001) and adverse events (p=0.019).

δDAS28 was comparable between non-TNFi and TNFi patient groups both at 6 [mean (SD): -1.16 (1.29) and -1.07 (1.55) respectively, p=0.296] and at 12 months [-1.41 (1.29) and -1.39 (1.26) respectively, p=0.670]. In patients who did not receive co-therapy with methotrexate, significantly greater δDAS28 was observed with a non-TNFi (-1.25 (1.29) vs.-0.68 (1.61), p=0.006). When the first TNFi was discontinued due to primary failure, we observed a trend for greater δDAS28 in the non-TNFi patient group compared to the 2nd TNFi group (-1.4 vs. -1.0, p=0.12) while the opposite was observed in patients who have experienced secondary failure to the 1st TNFi (-0.81 vs -1.48, p=0.18), but this did not reach statistical significance, probably due to the low number of available patients.

Conclusions In RA patients who need a 2nd bDMARD after discontinuation of a TNFi, administration of a non-TNFi results in similar clinical responses but higher treatment adherence compared to a second TNFi agent. In patients who do not receive methotrexate, responses are better with a non-TNFi bDMARD.

Disclosure of Interest None declared

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