RESEARCH - Effects of switching between anti-TNF therapies on HAQ response in patients who do not respond to their first anti-TNF drug

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Rheumatology (Oxford). 2008 Jul;47(7):1000-5. Epub 2008 Apr 17.

Effects of switching between anti-TNF therapies on HAQ response in

patients who do not respond to their first anti-TNF drug.

Hyrich KL, Lunt M, Dixon WG, KD, Symmons DP; BSR Biologics Register.

Arthritis Research Campaign Epidemiology Unit, University of Manchester, UK.

OBJECTIVES: Small studies have shown an improvement in disease

activity in patients with RA who have switched between anti-TNF

therapies for reasons of inefficacy. However, it is not clear whether

switching improves longer term outcomes, such as disability. This

analysis compares changes in HAQ scores 1 yr following lack of

response to a first anti-TNF based on subsequent treatment during that

year.

METHODS: Analysis was limited to RA patients with inefficacy to a

first anti-TNF based on (i) clinician opinion and/or (ii) disease

activity score in 28 joints and had an HAQ measured at time of

non-response and 12 months later. Patients were classified into three

groups based on treatment during the next 12 months: (i) continued

anti-TNF despite non-response; (ii) stopped anti-TNF with no further

biologics; and (iii) switched to a second anti-TNF. Mean improvement

in HAQ was compared among the groups using multivariable linear

regression models.

RESULTS: As of July 2006, 868 patients met the inclusion for this

analysis. Four hundred and seventy-nine patients stopped anti-TNF of

whom 331 switched to a second anti-TNF. Three hundred and eighty-nine

continued treatment. Patients who continued and those who switched had

improvements in HAQ over the 12 months, unlike patients who

discontinued all biologic therapy. The best improvement was seen in

those who switched [adjusted mean improvement in HAQ 0.15 (95% CI

0.26, 0.05)].

CONCLUSION: There is a significant improvement in HAQ in patients who

switch to a second anti-TNF, providing an effective next choice of

therapy for some patients who fail to respond to their first anti-TNF.

PMID: 18420660

http://www.ncbi.nlm.nih.gov/pubmed/18420660

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