RESEARCH - Treatment response to a second or third TNF inhibitor in RA

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Rheumatology Advance Access published online on February 27, 2008

Rheumatology, doi:10.1093/rheumatology/ken034

Treatment response to a second or third TNF-inhibitor in RA: results

from the South Swedish Arthritis Treatment Group Register

J. A. Karlsson, L. E. sen, M. C. Kapetanovic, A. Gülfe, T.

Saxne and P. Geborek

Department of Rheumatology, Lund University Hospital, SE 221 85 Lund, Sweden.

Abstract

Objectives. To study treatment response rates of RA patients

undergoing second- and third-line anti-TNF therapy and to identify

baseline predictors of response to second-line treatment.

Methods. RA patients monitored in a prospective, observational study,

having switched anti-TNF therapy once (first-time switchers, n = 337)

or twice (second-time switchers, n = 36)—i.e. following failures with

one antibody- and one receptor-type agent—between March 1999 and

December 2006, were studied. Treatment responses at 3 months were

assessed by the ACR and European League Against Rheumatism (EULAR)

response criteria. Predictive potentials for response to second-line

treatment of demographics, baseline disease activity measures, disease

and treatment characteristics were analysed using logistic regression.

Results. ACR20 response was met by 51% of first-time and 35% of

second-time switchers. Corresponding ACR50 rates were 27 and 18%;

EULAR overall rates (EULAR good or moderate response) 71 and 58%;

EULAR good rates 25 and 9% and 28-joint disease activity score (DAS28)

remission rates 16 and 6%. Identified baseline predictors of response

to second-line treatment were lower age and HAQ scores, elevated DAS28

values and having ceased the former anti-TNF treatment due to adverse

events rather than inefficacy. No variable was predictive for all

examined response criteria.

Conclusions. Response rates of first-time anti-TNF switchers are

somewhat below those of anti-TNF naïve RA patients, while the markedly

inferior response rates of second-time switchers suggest other

therapeutic options to be considered in this situation. Identified

baseline predictors of response may be useful indicators to

second-line anti-TNF therapy, but vary depending on the response

criteria set studied.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken034v1?papetoc

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