PT  - JOURNAL ARTICLE
AU  - Karen Minde Fagerli
AU  - Elisabeth Lie
AU  - Désirée van der Heijde
AU  - Marte Schrumpf Heiberg
AU  - Synøve Kalstad
AU  - Erik Rødevand
AU  - Knut Mikkelsen
AU  - Åse Stavland Lexberg
AU  - Tore K Kvien
TI  - Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study
AID  - 10.1136/annrheumdis-2012-203018
DP  - 2013 Nov 01
TA  - Annals of the Rheumatic Diseases
PG  - 1840--1844
VI  - 72
IP  - 11
4099  - http://ard.bmj.com/content/72/11/1840.short
4100  - http://ard.bmj.com/content/72/11/1840.full
SO  - Ann Rheum Dis2013 Nov 01; 72
AB  - 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.