Which subgroup of rheumatoid arthritis patients benefits from switching to tocilizumab versus etanercept after previous infliximab failure? A retrospective study

Efficacy of Switching from Infliximab to Subcutaneous Golimumab in Patients with Rheumatoid Arthritis to Control Disease Activity or Adverse Events

Background

Some rheumatoid arthritis (RA) patients initially respond to treatment with infliximab (IFX), but subsequently their responsiveness decreases.

Objectives

Our objective was to evaluate the efficacy and safety of switching from IFX to subcutaneous golimumab (GLM-SC) in RA patients.

Methods

Thirty-three patients who had been treated for a mean 4.4 years with IFX (3–6 mg/kg/8 weeks) were switched to GLM-SC to control disease activity or adverse events. The patients with low disease activity (LDA) or remission were divided into two groups: the LDA group and the LDA every 8 weeks (q8w) group, which included patients with LDA or remission who switched to GLM therapy with 50 mg at 4- and 8-week intervals, respectively. The moderate disease activity (MDA) group included patients with MDA who switched to GLM therapy with 50 mg at 4-week intervals. Effects of the IFX to GLM-SC switch were evaluated at weeks 12, 24, and 52 after switching.

Results

The mean disease activity score 28-ESR and -C-reactive protein values in the LDA and LDAq8w groups were maintained from baseline throughout the 52-week treatment period. The mean disease activity score 28 values at 12, 24, and 52 weeks in the MDA group were improved significantly compared with baseline. Treatment discontinuations due to adverse events occurred in one patient in the MDA group, and no serious adverse events occurred during the observation period in the LDA group or the LDAq8w group. The GLM continuation rates at 52 weeks were 100% in the LDA and LDAq8w groups and 83.3% in the MDA group. Thus, GLM-SC treatment regimens were effective in controlling disease activity and improving the clinical response related to adverse events caused by IFX.

Conclusion

The clinical efficacy of GLM-SC was sustained or improved in patients who switched from IFX without serious safety concerns.

What is the best biological treatment for rheumatoid arthritis? A systematic review of effectiveness

AIM: To evaluate the effectiveness of the biological disease-modifying antirheumatic drugs (bDMARD) in the treatment of rheumatoid arthritis through a systematic review of observational studies.

METHODS: The studies were searched in the PubMed, EMBASE, Cochrane Controlled Trials Register and LILACS databases (until August 2014), in the grey literature and conducted a manual search. The assessed criteria of effectiveness included the EULAR, the disease activity score (DAS), the Clinical Disease Activity Index, the Simplified Disease Activity Index, the American College of Rheumatology and the Health Assessment Questionnaire. The meta-analysis was performed with Review Manager^® 5.2 software using a random effects model. A total of 35 studies were included in this review.

RESULTS: The participants anti-tumor necrosis factor inhibitors (TNF) naïve, who used adalimumab (P = 0.0002) and etanercept (P = 0.0006) exhibited greater good EULAR response compared to the participants who used infliximab. No difference was detected between adalimumab and etanercept (P = 0.05). The participants who used etanercept exhibited greater remission according to DAS28 compared to the participants who used infliximab (P = 0.01). No differences were detected between adalimumab and infliximab (P = 0.12) or etanercept (P = 0.79). Better results were obtained with bDMARD associated with methotrexate than with bDMARD alone. The good EULAR response and DAS 28 was better for combination with methotrexate than bDMARD monotherapy (P = 0.03 e P < 0.00001). In cases of therapeutic failure, the participants who used rituximab exhibited greater DAS28 reduction compared to those who used anti-TNF agents (P = 0.0002). The participants who used etanercept achieved greater good EULAR response compared to those who did not use that drug (P = 0.007). Studies that assessed reduction of the CDAI score indicated the superiority of abatacept over rituximab (12.4 vs +1.7) and anti-TNF agents (7.6 vs 8.3). The present systematic review with meta-analysis found that relative to anti-TNF treatment-naïve patients, adalimumab and etanercept were more effective when combined with methotrexate than when used alone. Furthermore, in case of therapeutic failure with anti-TNF agents; rituximab and abatacept (non anti-TNF) and etanercept (as second anti-TNF) were more effective. However, more studies of effectiveness were found for the rituximab.

CONCLUSION: The best treatment for treatment-naïve patients is adalimumab or etanercept combined with methotrexate. For anti-TNF therapeutic failure, the best choice is rituximab, abatacept or etanercept.

Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis

Introduction

The aim of this study was to compare the response between subsequent use of anti-tumor necrosis factor α (anti-TNF) agents and biologic disease-modifying anti-rheumatic drugs (bDMARD) with other mechanism of action (MOA) in rheumatoid arthritis (RA) patients with history of anti-TNF treatment as their first bDMARD.

Methods

A retrospective chart review was conducted at eight community-based rheumatology practices in the United States in 2012. Routine Assessment of Patient Index Data 3 (RAPID3) response was measured by comparing baseline and 6-month scores. Poor response was defined as decrease <1.8 points, follow-up score >12, or treatment discontinuation before 6 months. Percentages of patients with good and good or moderate RAPID3 response were compared for second and third biologics. Multivariate models controlled for potential confounders.

Results

Of 176 patients whose charts were abstracted, 122 (69.3%) received another anti-TNF agent after they discontinued their first anti-TNF. RAPID3 scores were available for 160 patients. A patient receiving a second bDMARD with another MOA had a higher good or moderate response than a patient receiving anti-TNF (53.5 vs. 30.7%, p = 0.01). In the multivariate models, treatment with another MOA was more likely to produce a good RAPID3 response [odds ratio (OR), 2.42; 95% confidence interval (CI), 1.05–5.58] or a good or moderate response (OR, 2.21; 95% CI, 1.23–3.97) than treatment with an anti-TNF.

Conclusion

In patients who have discontinued anti-TNF agents as their first bDMARD, RAPID3 response rates are better for those receiving agents with a different MOA rather than another anti-TNF. Physicians should consider using a bDMARD with a different MOA as the next bDMARD for RA patients whose anti-TNF agent has failed.

Electronic supplementary material

The online version of this article (doi:10.1007/s40744-014-0002-7) contains supplementary material, which is available to authorized users.