TY - JOUR
T1 - Effectiveness of a second biologic after failure of a non-tumor necrosis factor inhibitor as first biologic in rheumatoid arthritis
AU - Chatzidionysiou, Katerina
AU - Hetland, Merete Lund
AU - Frisell, Thomas
AU - Di Giuseppe, Daniela
AU - Hellgren, Karin
AU - Glintborg, Bente
AU - Nordström, Dan
AU - Peltomaa, Ritva
AU - Aaltonen, Kalle
AU - Trokovic, Nina
AU - Kristianslund, Eirik K
AU - Kvien, Tore K
AU - Provan, Sella A
AU - Gudbjornsson, Bjorn
AU - Grondal, Gerdur
AU - Dreyer, Lene
AU - Kristensen, Lars Erik
AU - Jørgensen, Tanja Schjødt
AU - Jacobsson, Lennart T.H.
AU - Askling, Johan
PY - 2021/10/1
Y1 - 2021/10/1
N2 - OBJECTIVE: In Rheumatoid Arthritis (RA), evidence regarding the effectiveness of a second biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) in patients whose first ever bDMARD was a non-tumor-necrosis-factor-inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of the second bDMARD (non-TNFi [rituximab, abatacept or tocilizumab, separately] and TNFi) after failure of a non-TNFi bDMARD as first bDMARD. METHODS: We identified RA patients from the five Nordic biologics registers started treatment with a non-TNFi as first ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed survival-on-drug (at 6 and 12 months), and primary response (at 6 months). RESULTS: We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67 and TNFi 427) following failure of a first non-TNFI bDMARD. At 6 and 12 months after start of their second bDMARD, around 70% and 50%, respectively, remained on treatment, and at 6 months less than one third of patients were still on their second bDMARD and had reached low disease activity or remission according to DAS28. For those patients whose second bMDARD was a TNFI, the corresponding proportion was slightly higher (40%). CONCLUSION: The survival-on-drug and primary response of a second bDMARD in RA patients switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.
AB - OBJECTIVE: In Rheumatoid Arthritis (RA), evidence regarding the effectiveness of a second biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) in patients whose first ever bDMARD was a non-tumor-necrosis-factor-inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of the second bDMARD (non-TNFi [rituximab, abatacept or tocilizumab, separately] and TNFi) after failure of a non-TNFi bDMARD as first bDMARD. METHODS: We identified RA patients from the five Nordic biologics registers started treatment with a non-TNFi as first ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed survival-on-drug (at 6 and 12 months), and primary response (at 6 months). RESULTS: We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67 and TNFi 427) following failure of a first non-TNFI bDMARD. At 6 and 12 months after start of their second bDMARD, around 70% and 50%, respectively, remained on treatment, and at 6 months less than one third of patients were still on their second bDMARD and had reached low disease activity or remission according to DAS28. For those patients whose second bMDARD was a TNFI, the corresponding proportion was slightly higher (40%). CONCLUSION: The survival-on-drug and primary response of a second bDMARD in RA patients switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.
KW - Biologics
KW - Disease-modifying antirheumatic drugs
KW - Rheumatoid arthritis
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=85116640297&partnerID=8YFLogxK
U2 - 10.3899/jrheum.201467
DO - 10.3899/jrheum.201467
M3 - Journal article
SN - 0315-162X
VL - 48
SP - 1512
EP - 1518
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 10
M1 - jrheum.201467
ER -