M J L' Ami1, J Ruwaard1, Clm Krieckaert1, M T Nurmohamed1,2, R F van Vollenhoven1,2,3, T Rispens4, G J Wolbink1,4. 1. a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands. 2. b Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, UMC/VU University Medical Center , Amsterdam , The Netherlands. 3. c Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, UMC/Academic Medical Center , Amsterdam , The Netherlands. 4. d Department of Immunopathology , Sanquin Research and Landsteiner Laboratory Academic Medical Center , Amsterdam , The Netherlands.
Abstract
Objectives: Inadequate response to adalimumab can be caused by insufficient blockade of the target tumour necrosis factor (TNF) at low serum concentrations. In such cases, patients may respond to another TNF inhibitor. We investigated whether the serum adalimumab concentration is related to the efficacy of a second TNF inhibitor, etanercept, in rheumatoid arthritis (RA). Methods: Patients with RA starting etanercept treatment were prospectively observed in the Reade Rheumatology Registry. In patients previously on adalimumab, serum concentrations were determined before treatment discontinuation. According to this concentration, three subgroups were formed: < 0.5 μg/mL, 0.5-5.0 μg/mL, and ≥ 5.0 μg/mL. The European League Against Rheumatism (EULAR) good/moderate response rate after 52 weeks of etanercept was compared between the switcher subgroups and biologic-naive patients. Results: In total, 449 consecutive patients were included, of whom 69 switched from adalimumab (15%) and 380 were biologic naive (85%). EULAR good or moderate response was achieved by 74% of the biologic-naive patients and by 72%, 50%, and 52% of switchers with adalimumab concentration < 0.5 μg/mL, 0.5-5.0 μg/mL, and ≥ 5.0 μg/mL, respectively (p = 0.15). Patients with an adalimumab concentration ≥ 0.5 μg/mL were significantly less likely to achieve EULAR good/moderate response on etanercept compared to biologic-naive patients, whereas patients with a concentration < 0.5 μg/mL did not significantly differ from patients starting etanercept without prior biologic treatment. Conclusion: RA patients with an inadequate response to adalimumab, in the presence of sufficient drug concentrations, benefit less from switching to another TNF inhibitor, etanercept.
Objectives: Inadequate response to adalimumab can be caused by insufficient blockade of the target tumour necrosis factor (TNF) at low serum concentrations. In such cases, patients may respond to another TNF inhibitor. We investigated whether the serum adalimumab concentration is related to the efficacy of a second TNF inhibitor, etanercept, in rheumatoid arthritis (RA). Methods:Patients with RA starting etanercept treatment were prospectively observed in the Reade Rheumatology Registry. In patients previously on adalimumab, serum concentrations were determined before treatment discontinuation. According to this concentration, three subgroups were formed: < 0.5 μg/mL, 0.5-5.0 μg/mL, and ≥ 5.0 μg/mL. The European League Against Rheumatism (EULAR) good/moderate response rate after 52 weeks of etanercept was compared between the switcher subgroups and biologic-naive patients. Results: In total, 449 consecutive patients were included, of whom 69 switched from adalimumab (15%) and 380 were biologic naive (85%). EULAR good or moderate response was achieved by 74% of the biologic-naive patients and by 72%, 50%, and 52% of switchers with adalimumab concentration < 0.5 μg/mL, 0.5-5.0 μg/mL, and ≥ 5.0 μg/mL, respectively (p = 0.15). Patients with an adalimumab concentration ≥ 0.5 μg/mL were significantly less likely to achieve EULAR good/moderate response on etanercept compared to biologic-naive patients, whereas patients with a concentration < 0.5 μg/mL did not significantly differ from patients starting etanercept without prior biologic treatment. Conclusion:RApatients with an inadequate response to adalimumab, in the presence of sufficient drug concentrations, benefit less from switching to another TNF inhibitor, etanercept.
Authors: Charlotte Krieckaert; Borja Hernández-Breijo; Johanna Elin Gehin; Guillaume le Mélédo; Alejandro Balsa; Meghna Jani; Denis Mulleman; Victoria Navarro-Compan; Gertjan Wolbink; John Isaac; Astrid van Tubergen Journal: RMD Open Date: 2022-06
Authors: Maike H M Wientjes; Sadaf Atiqi; Gerrit Jan Wolbink; Michael T Nurmohamed; Maarten Boers; Theo Rispens; Annick de Vries; Ronald F van Vollenhoven; Bart J F van den Bemt; Alfons A den Broeder Journal: Trials Date: 2021-06-19 Impact factor: 2.279