Non-TNF-targeted Biologics Most Effective After RA Treatment Failure

For rheumatoid arthritis patients who have failed initial anti-tumor necrosis factor — or TNF — therapy, care providers should consider a non–TNF-targeted biologic over secondary anti-TNF agents. Although both approaches will likely improve patients’ conditions, a recent investigation suggests secondary treatment with a non–TNF-targeted agent will more often elicit an effective clinical response.

“TNF-inhibitors have improved the quality of life for patients with rheumatoid arthritis who show insufficient response to methotrexate,” Jacques-Eric Gottenberg, MD, PhD, of the department of rheumatology at Strasbourg University Hospital, and colleagues wrote in JAMA. “However, as many as one-third of patients have persistent disease activity and insufficient response to anti-TNF agents according to international recommendations. Therefore, alternatives are needed.”

To determine the best course of action following anti-TNF therapy failure, Dr Gottenberg and colleagues randomly assigned 300 arthritic patients with persistent disease activity to receive either a non–TNF-targeted biologic, or another anti-TNF drug. The choice of biologic prescribed within each arm was left to the discretion of the treating physician. The researchers compared the proportion of patients in each group with favorable clinical responses at 24 weeks, as well as the frequency of adverse events, disease remission and disease activity assessment scores at various time points.

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Approximately 69% of patients in the non–TNF-targeted biologic arm achieved a “good” or “moderate” response to the treatment, as opposed to 52% of those given a second anti-TNF drug (OR = 2.06; 95% CI, 1.27-3.37). 

Disease activity scores at 12 and 52 weeks were also lower among patients receiving a non–TNF-targeted biologic, who were also more likely to demonstrate low disease activity at 6 and 12 months. Eleven percent of the non-TNF cohort experienced at least one serious adverse event, compared to 5% of those receiving a second anti-TNF (P = .1). Eighteen percent of the non-TNF group and 33% of the anti-TNF group switched agents for various reasons, including inefficacy, adverse events and a desire to become pregnant.

Due to their study’s pragmatic design, the researcher wrote that these findings should be representative of normal clinical situations, as care providers often choose biologic agent on a patient-to-patient basis. However, additional studies will be necessary to examine the efficacy and safety of individual anti-TNF or non–TNF-targeted therapies.  —Dave Muoio