Patients with rheumatoid arthritis (RA) previously treated to a first-line anti-tumor necrosis factor (TNF) drug who have an inadequate response may experience a better outcome with a non-TNF biologic agent than with a second anti-TNF therapy, according to new findings published in JAMA.
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Although the study demonstrated that approximately 50% of patients with insufficient response to a TNF-a inhibitor might respond to a second anti-TNF agent, “The proportion of EULAR [European League Against Rheumatism] response at week 24 was greater among those treated with a non-TNF-targeted biologic than those treated with a second anti-TNF biologic,” said the researchers.
The multicenter, open-label, parallel-group, randomized clinical trial enrolled 300 adults with RA who had persistent disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) ³3.2 and who had experienced an insufficient response to anti-TNF therapy, according to their physician.
Patients were randomly assigned 1:1 to receive either a non-TNF biologic (ie, abatacept, rituximab, or tocilizumab) or a second anti-TNF agent (adalimumab, certolizumab, etanercept, infliximab, or golimumab). The primary endpoint was the proportion of patients with a good or moderate response according to the EULAR scale at week 24. Secondary endpoints included the EULAR response at weeks 12 and 52 and DAS28-ESR at weeks 12, 24, and 52.
At week 24, 69% of patients achieved an effective clinical response in the non-TNF biologic group compared with 52% of patients in the second anti-TNF group (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.27-3.37; P=.004). The DAS28-ESR was lower in the non-TNF group vs the second anti-TNF group (mean difference adjusted for baseline difference, -0.43, 95% CI, -0.72 to -0.14; P=.004). Also at weeks 24 and 52, more patients in the non-TNF group compared with second anti-TNF group demonstrated low disease activity (45% vs 28% at week 24; OR, 2.09; 95% CI, 1.27-3.43; P=.004) and 41% vs 23% at week 52 (OR, 2.26; 95% CI, 1.33-3.86; P=.003).
