Efficacy in current practice of switching between anti-tumour necrosis factor-α agents in spondyloarthropathies

• Published in: Rheumatology (Oxford, England) England), 2011-04, Vol.50 (4), p.714-720
• Main Authors: PACCOU, Julien, SOLAU-GERVAIS, Elisabeth, HOUVENAGEL, Eric, SALLERON, Julia, LURASCHI, Hélène, PHILIPPE, Peggy, DUQUESNOY, Bernard, FLIPO, René-Marc
• Format: Article
• Language: English
• Subjects: Adalimumab; Adult; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Diseases of the osteoarticular system; Diseases of the spine; Etanercept; Female; Humans; Immunoglobulin G - adverse effects; Immunoglobulin G - therapeutic use; Inflammatory joint diseases; Infliximab; Logistic Models; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Practice Guidelines as Topic; Receptors, Tumor Necrosis Factor - therapeutic use; Retrospective Studies; Spondylarthropathies - drug therapy; Treatment Failure; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keq377

Anti-TNF-α agents are remarkably effective in the treatment of SpAs. However, 30% of patients withdraw from anti-TNF-α agents yearly because of inadequate efficacy or side effects. The objective of this study was to assess in current practice the response to a second and a third anti-TNF-α. Retrospectively, all records of patients who had received at least two anti-TNF-α agents have been studied. For axial forms, treatment was considered effective if 3 months after switching the patient had a favourable expert opinion or showed an improvement in BASDAI of at least 2 on a scale of 0-10 or an improvement of 50% (BASDAI 50). For peripheral forms, the treatment was considered effective if the patient had a favourable expert opinion or if a clinical improvement of >30% of the swollen and tender joint counts was established. The reasons for switching were: (i) primary non-responder; (ii) loss of efficacy; and (iii) occurrence of side effects. To identify response predictor factors bivariate analysis was performed. Three hundred and seventy-seven patients under anti-TNF-α agents were treated and 99 patients had received at least two anti-TNF-α agents. Twenty-eight of these 99 patients had been treated with three anti-TNF-α agents. Following the failure of a first anti-TNF-α, the response to a second agent was satisfactory in 80.8%. Patients who had received a third anti-TNF-α following failure of the first two also showed a satisfactory response in 82.1%. The reason for switching from the first or second agent was not predictive of the response. In the event of failure or intolerance to anti-TNF-α in the treatment of SpAs, performing a first or second switch produces a satisfactory therapeutic response.