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.
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.
Authors: Giovanni Damiani; Rosalynn R Z Conic; Valerio de Vita; Antonio Costanzo; Roberto Regazzini; Paolo D M Pigatto; Nicola L Bragazzi; Alessia Pacifico; Piergiorgio Malagoli Journal: Dermatol Ther Date: 2018-12-21 Impact factor: 2.851
Authors: Gustavo Deza; Jaime Notario; Marta Ferran; Emma Beltrán; Miriam Almirall; Rebeca Alcalá; José Carlos Ruiz-Carrascosa; Ricardo Sánchez; Silvia Pérez; María Luz García-Vivar; Eva Galíndez; Maribel Mora; Jesús Rodríguez; Fernando Gallardo Journal: Rheumatol Int Date: 2018-08-24 Impact factor: 2.631
Authors: Rieke Alten; P G Conaghan; V Strand; E Sullivan; S Blackburn; H Tian; K Gandhi; S M Jugl; A Deodhar Journal: Clin Rheumatol Date: 2019-02-04 Impact factor: 2.980