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Abstract
Introduction/Objective: The efficacy of biologic therapy in the treatment of rheumatoid arthritis (RA) has been well-established but, in practice, a quarter of patients will either not respond to the first biologic agent or will suffer an adverse event requiring a switch to a different drug. While clinical guidelines exist to help guide therapy and previous studies have examined sequential use of anti-TNF agents, there is little data to inform a multiple switch strategy. Our aim was to measure the efficacy of multiple switches of biologic in severe refractory RA. Methods: We enrolled 111 patients whose therapy with one anti-TNF agent had failed in this open-label observational study. These patients were all treated with a second biologic agent and 27 ultimately required treatment with a third. The response to the therapy and disease activity were assessed at 6 and 12 months after each switch. Results: The remission rates at 6 months were lower than previously reported and the initiation of a second biologic agent resulted in significant improvement at 12 months, including DAS remission in 36% of patients. The response in those receiving a third biologic was less pronounced, as might be expected in this relatively treatment-refractory population. In this group, only patients treated with tocilizumab had maintained remission at one year. Conclusion: Patients who do not respond to an anti-TNF agent often benefit from being switched to a second, or even third, biologic. Importantly, it may take longer than expected to fully assess the effectiveness of a second or third agent in patients with refractory disease.
Document Type
Article
Publication Date
12-21-2021
Digital Object Identifier (DOI)
https://doi.org/10.3390/rheumato1010005
Related Content
The data presented in this study are available on request from the corresponding author.
Repository Citation
Versace, Antonio Giovanni; Aragona, Caterina Oriana; La Rosa, Daniela; Chiappalone, Marianna; Tringali, Maria Concetta; De Gaetano, Alberta; Moore, Charles Frederick Jr.; Sangari, Donatella; Roberts, William Neal; and Bagnato, Gianluca, "The Efficacy of Sequential Biologic Agents in Refractory Rheumatoid Arthritis After Failure of Initial DMARD and Anti-Tumor Necrosis Factor Therapy" (2021). Internal Medicine Faculty Publications. 280.
https://uknowledge.uky.edu/internalmedicine_facpub/280
Notes/Citation Information
Published in Rheumato, v. 1, issue 1.
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).