Switching between TNFα antagonists in rheumatoid arthritis: Personal experience and review of the literature

Objective: To evaluate the clinical response after switching to another TNFα antagonist in patients with rheumatoid arthritis (RA) and provide a review of the literature on this topic. Methods: In this ongoing, longitudinal, observational study we have prospectively collected data of patients starting biological treatments since 2000. The present analysis is restricted to RA patients who switched to another anti-TNFα due to lack of efficacy (LaE), loss of efficacy (LoE), or adverse events (AEs) by the end of December 2007. Disease activity score (ESR-based DAS28) was calculated and the clinical response (none, moderate, good) was evaluated according to the European League Against Rheumatism (EULAR) criteria. Clinical remission (DAS28 <2.6) and low disease activity (DAS28 ≤3.2) were also evaluated. Results: A total of 692 anti-TNFα-naïve patients has been registered, of whom 395 with a diagnosis of RA. Thirtyseven RA patients switched to another TNFα antagonist. Three months after switching, the proportion of patients with remission, low disease activity, good and moderate/good EULAR responses grew from 0%, 2.7%, 0%, and 5.4% (baseline before switching) to 16.2%, 35.1%, 27%, and 62.2% (p<0.05, p<0.001, p<0.001, p<0.000001, respectively). Of the patients who switched because of LaE, LoE, and AEs a moderate/good EULAR response was achieved in 38.4%, 66.6%, and 88.8% of patients, respectively. Mean treatment duration with the second anti-TNFa was significantly longer in patients switching for LoE and AEs than in those switching for LaE (p<0.05). Conclusions: The findings of this study suggest that RA patients may be successfully treated with another TNFα antagonist, especially those withdrawing for LoE or AEs.