Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study. Issue 11 (5th April 2013)

• Record Type: Journal Article
• Authors: Fagerli, Karen Minde; Lie, Elisabeth; van der Heijde, Désirée; Heiberg, Marte Schrumpf; Kalstad, Synøve; Rødevand, Erik; Mikkelsen, Knut; Lexberg, Åse Stavland; Kvien, Tore K
• Is Part Of: Annals of the rheumatic diseases. Volume 72:Issue 11(2013)
• Page Start: 1840
• Page End: 1844
• Publication Date: 2013-04-05
• Subjects: Anti-TNF -- Psoriatic Arthritis -- Treatment; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2012-203018
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : 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.