Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study

• Published in: Annals of the rheumatic diseases Vol. 72; no. 11; p. 1840
• Main Authors: Fagerli, Karen Minde, Lie, Elisabeth, van der Heijde, Désirée, Heiberg, Marte Schrumpf, Kalstad, Synøve, Rødevand, Erik, Mikkelsen, Knut, Lexberg, Ase Stavland, Kvien, Tore K
• Format: Journal Article
• Language: English
• Published: England 01-11-2013
• Subjects: Adalimumab; Adult; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - drug therapy; Certolizumab Pegol; Drug Substitution; Etanercept; Female; Humans; Immunoglobulin Fab Fragments - therapeutic use; Immunoglobulin G - therapeutic use; Infliximab; Longitudinal Studies; Male; Middle Aged; Polyethylene Glycols - therapeutic use; Receptors, Tumor Necrosis Factor - therapeutic use; Remission Induction - methods; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Anti-TNF; Psoriatic Arthritis; Treatment
• ISSN: 1468-2060
• DOI: 10.1136/annrheumdis-2012-203018

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.
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.
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.
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.