Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis

Katerina Chatzidionysiou; Merete Lund Hetland; Thomas Frisell; Daniela Di Giuseppe; Karin Hellgren; Bente Glintborg; Dan Nordström; Ritva Peltomaa; Kalle Aaltonen; Nina Trokovic; Eirik K Kristianslund; Tore K Kvien; Sella A Provan; Bjorn Gudbjornsson; Gerdur Grondal; Lene Dreyer; Lars Erik Kristensen; Tanja Schjødt Jørgensen; Lennart T H Jacobsson; Johan Askling

doi:10.3899/jrheum.201467

Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis

Katerina Chatzidionysiou, Merete Lund Hetland, Thomas Frisell, Daniela Di Giuseppe, Karin Hellgren, Bente Glintborg, Dan Nordström, Ritva Peltomaa, Kalle Aaltonen, Nina Trokovic, Eirik K Kristianslund, Tore K Kvien, Sella A Provan, Bjorn Gudbjornsson, Gerdur Grondal, Lene Dreyer, Lars Erik Kristensen, Tanja Schjødt Jørgensen, Lennart T H Jacobsson, Johan Askling

Abstract

OBJECTIVE: In rheumatoid arthritis (RA), evidence regarding the effectiveness of a second biologic disease-modifying antirheumatic drug (bDMARD) in patients whose first-ever bDMARD was a non-tumor necrosis factor inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of a second bDMARD (non-TNFi: rituximab [RTX], abatacept [ABA], or tocilizumab [TCZ], separately; and TNFi) after failure of a non-TNFi bDMARD as first bDMARD.

METHODS: We identified patients with RA from the 5 Nordic biologics registers who started treatment with a non-TNFi as first-ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed drug survival (at 6 and 12 months) and primary response (at 6 months).

RESULTS: We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67, and TNFi 427) following failure of a first non-TNFi bDMARD. At 6 and 12 months after start of their second bDMARD, approximately 70% and 60%, respectively, remained on treatment, and at 6 months, less than one-third of patients were still on their second bDMARD and had reached low disease activity or remission according to the Disease Activity Score in 28 joints. For those patients whose second bMDARD was a TNFi, the corresponding proportion was slightly higher (40%).

CONCLUSION: The drug survival and primary response of a second bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.

Original language	English
Journal	Journal of Rheumatology
Volume	48
Issue number	10
Pages (from-to)	1512-1518
Number of pages	7
ISSN	0315-162X
DOIs	https://doi.org/10.3899/jrheum.201467
Publication status	Published - Oct 2021

Keywords

Antirheumatic Agents/therapeutic use
Arthritis, Rheumatoid/drug therapy
Biological Products/therapeutic use
Humans
Registries
Tumor Necrosis Factor Inhibitors

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Chatzidionysiou, K., Hetland, M. L., Frisell, T., Di Giuseppe, D., Hellgren, K., Glintborg, B., Nordström, D., Peltomaa, R., Aaltonen, K., Trokovic, N., Kristianslund, E. K., Kvien, T. K., Provan, S. A., Gudbjornsson, B., Grondal, G., Dreyer, L., Kristensen, L. E., Jørgensen, T. S., Jacobsson, L. T. H., & Askling, J. (2021). Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis. Journal of Rheumatology, 48(10), 1512-1518. https://doi.org/10.3899/jrheum.201467

Chatzidionysiou, K, Hetland, ML, Frisell, T, Di Giuseppe, D, Hellgren, K, Glintborg, B, Nordström, D, Peltomaa, R, Aaltonen, K, Trokovic, N, Kristianslund, EK, Kvien, TK, Provan, SA, Gudbjornsson, B, Grondal, G, Dreyer, L, Kristensen, LE , Jørgensen, TS, Jacobsson, LTH & Askling, J 2021, 'Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis', Journal of Rheumatology, vol. 48, no. 10, pp. 1512-1518. https://doi.org/10.3899/jrheum.201467

@article{12adadca1edf4925867b27f6548caf43,

title = "Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis",

abstract = "OBJECTIVE: In rheumatoid arthritis (RA), evidence regarding the effectiveness of a second biologic disease-modifying antirheumatic drug (bDMARD) in patients whose first-ever bDMARD was a non-tumor necrosis factor inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of a second bDMARD (non-TNFi: rituximab [RTX], abatacept [ABA], or tocilizumab [TCZ], separately; and TNFi) after failure of a non-TNFi bDMARD as first bDMARD.METHODS: We identified patients with RA from the 5 Nordic biologics registers who started treatment with a non-TNFi as first-ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed drug survival (at 6 and 12 months) and primary response (at 6 months).RESULTS: We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67, and TNFi 427) following failure of a first non-TNFi bDMARD. At 6 and 12 months after start of their second bDMARD, approximately 70% and 60%, respectively, remained on treatment, and at 6 months, less than one-third of patients were still on their second bDMARD and had reached low disease activity or remission according to the Disease Activity Score in 28 joints. For those patients whose second bMDARD was a TNFi, the corresponding proportion was slightly higher (40%).CONCLUSION: The drug survival and primary response of a second bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.",

keywords = "Antirheumatic Agents/therapeutic use, Arthritis, Rheumatoid/drug therapy, Biological Products/therapeutic use, Humans, Registries, Tumor Necrosis Factor Inhibitors",

author = "Katerina Chatzidionysiou and Hetland, {Merete Lund} and Thomas Frisell and {Di Giuseppe}, Daniela and Karin Hellgren and Bente Glintborg and Dan Nordstr{\"o}m and Ritva Peltomaa and Kalle Aaltonen and Nina Trokovic and Kristianslund, {Eirik K} and Kvien, {Tore K} and Provan, {Sella A} and Bjorn Gudbjornsson and Gerdur Grondal and Lene Dreyer and Kristensen, {Lars Erik} and J{\o}rgensen, {Tanja Schj{\o}dt} and Jacobsson, {Lennart T H} and Johan Askling",

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year = "2021",

month = oct,

doi = "10.3899/jrheum.201467",

language = "English",

volume = "48",

pages = "1512--1518",

journal = "Journal of Rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology Publishing Co. Ltd",

number = "10",

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TY - JOUR

T1 - Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis

AU - Chatzidionysiou, Katerina

AU - Hetland, Merete Lund

AU - Frisell, Thomas

AU - Di Giuseppe, Daniela

AU - Hellgren, Karin

AU - Glintborg, Bente

AU - Nordström, Dan

AU - Peltomaa, Ritva

AU - Aaltonen, Kalle

AU - Trokovic, Nina

AU - Kristianslund, Eirik K

AU - Kvien, Tore K

AU - Provan, Sella A

AU - Gudbjornsson, Bjorn

AU - Grondal, Gerdur

AU - Dreyer, Lene

AU - Kristensen, Lars Erik

AU - Jørgensen, Tanja Schjødt

AU - Jacobsson, Lennart T H

AU - Askling, Johan

PY - 2021/10

Y1 - 2021/10

N2 - OBJECTIVE: In rheumatoid arthritis (RA), evidence regarding the effectiveness of a second biologic disease-modifying antirheumatic drug (bDMARD) in patients whose first-ever bDMARD was a non-tumor necrosis factor inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of a second bDMARD (non-TNFi: rituximab [RTX], abatacept [ABA], or tocilizumab [TCZ], separately; and TNFi) after failure of a non-TNFi bDMARD as first bDMARD.METHODS: We identified patients with RA from the 5 Nordic biologics registers who started treatment with a non-TNFi as first-ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed drug survival (at 6 and 12 months) and primary response (at 6 months).RESULTS: We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67, and TNFi 427) following failure of a first non-TNFi bDMARD. At 6 and 12 months after start of their second bDMARD, approximately 70% and 60%, respectively, remained on treatment, and at 6 months, less than one-third of patients were still on their second bDMARD and had reached low disease activity or remission according to the Disease Activity Score in 28 joints. For those patients whose second bMDARD was a TNFi, the corresponding proportion was slightly higher (40%).CONCLUSION: The drug survival and primary response of a second bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.

AB - OBJECTIVE: In rheumatoid arthritis (RA), evidence regarding the effectiveness of a second biologic disease-modifying antirheumatic drug (bDMARD) in patients whose first-ever bDMARD was a non-tumor necrosis factor inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of a second bDMARD (non-TNFi: rituximab [RTX], abatacept [ABA], or tocilizumab [TCZ], separately; and TNFi) after failure of a non-TNFi bDMARD as first bDMARD.METHODS: We identified patients with RA from the 5 Nordic biologics registers who started treatment with a non-TNFi as first-ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed drug survival (at 6 and 12 months) and primary response (at 6 months).RESULTS: We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67, and TNFi 427) following failure of a first non-TNFi bDMARD. At 6 and 12 months after start of their second bDMARD, approximately 70% and 60%, respectively, remained on treatment, and at 6 months, less than one-third of patients were still on their second bDMARD and had reached low disease activity or remission according to the Disease Activity Score in 28 joints. For those patients whose second bMDARD was a TNFi, the corresponding proportion was slightly higher (40%).CONCLUSION: The drug survival and primary response of a second bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.

KW - Antirheumatic Agents/therapeutic use

KW - Arthritis, Rheumatoid/drug therapy

KW - Biological Products/therapeutic use

KW - Humans

KW - Registries

KW - Tumor Necrosis Factor Inhibitors

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U2 - 10.3899/jrheum.201467

DO - 10.3899/jrheum.201467

M3 - Journal article

C2 - 33649069

SN - 0315-162X

VL - 48

SP - 1512

EP - 1518

JO - Journal of Rheumatology

JF - Journal of Rheumatology

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ER -

Effectiveness of a Second Biologic After Failure of a Non-tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis

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