RESEARCH - Outcomes after switching from one ant-TNF-alpha agent to a second in patients with RA

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Arthritis Rheum. 2007 Jan;56(1):13-20.

Outcomes after switching from one anti-tumor necrosis factor alpha agent to

a second anti-tumor necrosis factor alpha agent in patients with rheumatoid

arthritis: results from a large UK national cohort study.

Hyrich KL, Lunt M, KD, Symmons DP, Silman AJ; British Society for

Rheumatology Biologics Register.

University of Manchester, Manchester, UK.

OBJECTIVE: Patients with rheumatoid arthritis (RA) who experience treatment

failure with one anti-tumor necrosis factor (anti-TNF) agent, due to either

inefficacy or toxicity, are frequently switched to a second anti-TNF agent,

although the benefits of switching are unknown. The present study was

undertaken to compare drug continuation rates between the first course and

second course of anti-TNF therapy. METHODS: The study involved a prospective

cohort of RA patients from a UK national register of new anti-TNF treatment

starts (n = 6,739; 876 starting adalimumab, 2,826 starting etanercept, and

starting 3,037 infliximab). Over a mean 15 months of followup, 841 patients

stopped taking the first drug due to inefficacy and 1,023 stopped the first

drug due to toxicity, of whom 503 and 353, respectively, were switched to a

second anti-TNF agent. Kaplan-Meier survival curves were plotted to

determine continuation rates for each course, and regression was used to

compare each course for the risk of stopping and the reason for stopping

(inefficacy or toxicity). RESULTS: Overall, 73% of patients who switched to

a second anti-TNF agent remained on the new therapy by the end of followup.

First drug discontinuation due to inefficacy was associated with an

increased rate of second drug discontinuation due to inefficacy (hazard

ratio

---

2.7, 95% confidence interval [95% CI] 2.1-3.4) but not toxicity

(HR 1.1, 95% CI 0.9-1.5). Similarly, first drug discontinuation due to

toxicity was associated with an increased rate of second drug

discontinuation due to toxicity (HR 2.3, 95% CI 1.9-2.9) but not inefficacy

(HR 1.2, 95% CI 0.8-1.6).

CONCLUSION: RA patients who are switched to a second anti-TNF drug have high

rates of continuation, although among those who must discontinue treatment,

the reasons for stopping a second drug are related to the reasons for

stopping the first drug. This large data set from the UK provides the first

estimates of the magnitude of these effects in patients with long-standing

severe RA.

PMID: 17195186

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