Greater Biologic Response After Second Response Failure to TNFi
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San Diego — Patients with rheumatoid arthritis (RA) who slowly lose response to initial tumour necrosis factor alpha inhibitor (TNFi) therapy have a greater response to biologics with a different mode of action (BDMA) compared with a different TNFi, according to findings from a retrospective observational study presented at the 2017 Annual Meeting, held November 3-8.
“Treatment of RA has been revolutionized by the introduction of TNFi,” wrote lead study investigator Dr Muhammad Shipa, from the department of rheumatology and general internal medicine at North Middlesex University Hospital NHS trust in London, United Kingdom. He noted that the criteria for determining whether a second TNFi or BDMA should be given to patients with secondary failure to TNFi requires further clinical clarification.
Investigators retrospectively compared real-life patients who presented with secondary failure to first-line TNFi and then received either another TNFi or BDMA. The investigators also sought to determine a potential association between therapeutic response and antibody status. Based on the European League Against Rheumatism (EULAR) criteria, response to treatment was defined as a moderate therapy response at 6 months.
In the final analysis, researchers included 422 patients with RA. Patients receiving TNFi (n=211) and BDMA (n=211) were randomly selected for evaluation. The Disease Activity Score 28 (DAS28) at baseline was significantly higher in patients receiving BDMA vs. TNFi (5.90 vs. 5.20; P <.01).
A higher percentage of patients responded to BDMA vs. another TNFi (70% vs. 35%, respectively; P <.01). Seropositive patients receiving rituximab (RTX) or tocilizumab (TCZ) had better response rates (75% and 68%, respectively) compared with 46% of seropositive responders to abatacept ([ABT] P <.01). Response to RTX was low in seronegative patients (35%) compared with ABT or TCZ in the same patient population (83% and 74%, respectively).
The investigators concluded that their findings may “suggest that seropositive patients may benefit from switching to RTX or TCZ, [mean]while seronegative patients may do better with ABT or TCZ.”
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Shipa M, Cicco MD, Balogh E, et al. Tailoring second-line biologic therapy in rheumatoid arthritis: new findings on the usefulness of antibody status to optimise drug selection. Presented at: ACR/ARHP 2017 Annual Meeting; November 3-8, 2017; San Diego, California. Abstract 1433.