Key result
Switching to a non-TNF inhibitor was associated with a significantly higher retention ratio and EULAR good response at 6 months compared to cycling TNF inhibitors (P<0.05).
Why the study?
To compare the therapeutic efficacy of TNFi cyclers and non-TNFi switchers in patients with RA who had an inadequate response to previous TNFis using composite measures including PDUS imaging assessment.
Does switching to a non-TNFi biologic improve therapeutic efficacy and retention compared to cycling TNFis in RA patients with inadequate response to previous TNFis?
Cohort (n=56)
Yes
Does switching to a non-TNFi biologic improve therapeutic efficacy and retention compared to cycling TNFis in RA patients with inadequate response to previous TNFis?
In RA patients with inadequate response to TNF inhibitors, switching to a non-TNFi biologic agent is associated with higher retention and better clinical response compared to cycling to another TNFi.
Answers are grounded in this paper and cite their sources.
Non-TNFi switching may improve retention and EULAR response in TNF-IR RA; leaves open need for randomized trials with PDUS.
To compare therapeutic efficacy of tumour necrosis factor inhibitor (TNFi) cyclers and non-TNFi switchers in patients with rheumatoid arthritis (RA) having inadequate response to previous TNFis (TNF-IR patients) using composite measures including imaging assessment with power Doppler ultrasonography (PDUS). Patients with RA who had inadequate response to one or more previous TNFi agents with moderate or higher disease activity were enrolled. The outcomes of 56 TNF-IR patients were analysed. Patients were divided into 19 TNFi cyclers and 37 non-TNFi switchers (16 abatacept [ABT] and 21 tocilizumab [TCZ] switchers). Retention ratio at 6 months was significantly higher in non-TNFi switchers than in TNFi cyclers (p < .05). Although there was no significant difference, non-TNFi switchers tended to have a larger decrease than TNFi cyclers in efficacy indicators based on clinical disease activity index and PDUS. Multivariate logistic regression analysis identified a following independent factor associated with both EULAR good response and retention of a biologic agent: non-TNFi switch (p < .05 for both). Non-TNFi switchers were shown to have significantly higher percentage of EULAR good response and higher retention than TNFi cyclers. A non-TNFi biologic agent may hence be a preferential next-line treatment for TNF-IR patients.
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Endo et al. (2020) conducted a cohort in Rheumatoid arthritis (n=56). Non-TNF inhibitor switch vs. TNF inhibitor cyclers was evaluated on Retention ratio and EULAR good response (p=<0.05). Switching to a non-TNF inhibitor was associated with a significantly higher retention ratio and EULAR good response at 6 months compared to cycling TNF inhibitors (P<0.05).
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