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Abstract Number: 2487

Comparison the Long-Term Clinical Outcomes between Non Anti-TNF Versus Anti-TNF in RA Patients Who Failed to a First Anti-TNF

Patricia Bogas1, Chamaida Plasencia-Rodriguez1, Alejandro Balsa1, Victoria Navarro-Compán2, Gema Bonilla1, Enrique Moral Coro1, Carolina Tornero1, Laura Nuño1 and Diana Peiteado3, 1Hospital Universitario La Paz, Madrid, Spain, 2Rheumatology, Hospital Universitario La Paz, Madrid, Spain, 3Rheumatology, La Paz University Hospital, Madrid, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Anti-TNF therapy and rheumatoid arthritis (RA), Biologic agents, Clinical Response

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Session Information

Date: Tuesday, November 7, 2017

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy Poster III: Efficacy and Safety of Originator Biologics and Biosimilars

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: There are many biological therapies for Rheumatoid Arthritis (RA) with different mechanisms of action and good efficacy rate; however, up to 40% of patients (pts) fail to respond to the 1st biologic agent, and it is still not clear what strategy to follow after showing inadequate response to tumor necrosis factor α inhibitors (TNFi). Our objective was to assess the clinical response and survival (SVV), in our cohort of RA pts that discontinued the 1st TNFi, of a 2nd TNFi vs a nonTNFi, both in the global cohort and in the subpopulation that dropped out the 1st TNFi due to inefficacy

Methods: This observational study included 149 pts in the RA-Paz cohort who previously suspended Infliximab, Adalimumab, Etanercept and Certolizumab between 1999-2016. Two groups were established as they switched to a TNFi or nonTNFi. Clinical response was evaluated by DAS28, Delta-DAS28 (ΔDAS28) and EULAR response (E-resp). The assessments were performed at 6 (v-6) and 12 months (v-12) since initiating 2nd biological agent and during the last visit prior to drug discontinuation or ending of the study for those who did not interrupt the drug (v-end). T tests and Fisher’s exact test were used to test statistical differences. Analysis was performed using SPSS 20.0

Results: Of the 149 pts who had stopped their 1st TNFi, 61% changed to a 2nd TNFi. The 81% of the overall pts were women. The mean age was 62±14 years and the mean time of 2nd biologic drug was 3.03±3.2 years. 58% associated methotrexate at the beginning of 2nd biologic agent, without differences between groups. At v-6 and v-12, there was no difference in ΔDAS28 [at v-6:1.3±1.4 in TNFi and 1.2±1.2 in nonTNFi (p=0.95), at v-12: 1.3±1.4 in TNFi and 1.4± 1.1 in nonTNFi (p=0.88)]. In contrast, at v-end, pts with nonTNFi showed a higher clinical improvement (ΔDAS28: 0.8±1.7 in TNF-i, 1.7±1.2 in nonTNFi, p= 0.001). At v-6, the TNFi group achieved higher good E-resp rate (39% vs 18%, p=0.01), but there was no difference at v-12 (34% in TNF-I vs 23% in nonTNFi, p=0.42). However, at v-end, the nonTNFi group achieved better E-resp (good resp: 37% in nonTNFi vs 26% in TNFi, no resp 18% in nonTNFi vs 50% in TNFi, p=0.005). Likewise, 100% (n=9) of the pts that finished 2nd biologic agent by remission, had changed to a nonTNFi (p<0.00001). There were no differences regarding 2nd biologic drug SVV (mean SVV time of 5.2±0.6 in TNFi, 4.4±0.5 in nonTNFi, p=0.507). A multivariate analysis adjusted for possible confounding factors (sex, age, smoking, RF, anti-CCP and basal DAS28 and DMARDs) was performed; same behavior as in the main analysis was observed. When analyzing the cohort that discontinued 1st TNFi because of inefficacy, at v-6 and v-12 there were no differences between switchers to TNFi and nonTNFi in ΔDAS28 (p=0.192), but at v-end, the nonTNFi group reached a higher ΔDAS28 (0.9±1.5 in TNFi, 1.7 ± 1 in nonTNFi, p=0.031)

Conclusion: In our sample of RA patients who suspended Ifx/Ada/Etn/Ctz as 1st TNFi, switching to a 2nd biologic agent did not show relevant clinical differences between a TNFi and a nonTNFi within the 1st year of treatment. However, in the long-term, switching to a nonTNFi shows enhanced clinical benefits with no impact on survival vis-à-vis a 2nd TNFi. Despite the efficacy of TNFi, new therapeutic targets are needed.


Disclosure: P. Bogas, None; C. Plasencia-Rodriguez, None; A. Balsa, None; V. Navarro-Compán, None; G. Bonilla, None; E. Moral Coro, None; C. Tornero, None; L. Nuño, None; D. Peiteado, None.

To cite this abstract in AMA style:

Bogas P, Plasencia-Rodriguez C, Balsa A, Navarro-Compán V, Bonilla G, Moral Coro E, Tornero C, Nuño L, Peiteado D. Comparison the Long-Term Clinical Outcomes between Non Anti-TNF Versus Anti-TNF in RA Patients Who Failed to a First Anti-TNF [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/comparison-the-long-term-clinical-outcomes-between-non-anti-tnf-versus-anti-tnf-in-ra-patients-who-failed-to-a-first-anti-tnf/. Accessed .
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