Comparison of the efficacy and risk of discontinuation between non-TNF-targeted treatment and a second TNF inhibitor in patients with rheumatoid arthritis after first TNF inhibitor failure
| Title: | Comparison of the efficacy and risk of discontinuation between non-TNF-targeted treatment and a second TNF inhibitor in patients with rheumatoid arthritis after first TNF inhibitor failure |
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| Authors: | Dong-Jin Park, Sung-Eun Choi, Ji-Hyoun Kang, Kichul Shin, Yoon-Kyoung Sung, Shin-Seok Lee |
| Source: | Therapeutic Advances in Musculoskeletal Disease, Vol 14 (2022) |
| Publisher Information: | SAGE Publishing, 2022. |
| Publication Year: | 2022 |
| Collection: | LCC:Diseases of the musculoskeletal system |
| Subject Terms: | Diseases of the musculoskeletal system, RC925-935 |
| More Details: | Objectives: Despite improved care for rheumatoid arthritis (RA) patients, many still experience treatment failure with biologic disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic DMARDs [tsDMARDs; typically Janus kinase inhibitors (JAKi)], and eventually switch to other agents. We compared the efficacy of a second tumor necrosis factor inhibitor (TNFi) and non-TNF-targeted treatment as the second-line treatment in patients showing an insufficient response to the first TNFi. Methods: Patients were included if they had received at least one prescription for a TNFi, and at least one follow-up prescription for a second TNFi or non-TNF-targeted treatment after discontinuation of the first drug. In total, 209 patients were analyzed, including 69 with a second TNFi and 140 with a non-TNF-targeted treatment (106 non-TNFi biologics and 34 JAKi). Cox regression was used to estimate the hazard ratio (HR) for discontinuation. Results: The mean follow-up period after switching was 28.0 (range: 0–80) months and 24.4% of the 209 patients switched or discontinued the second drug. In multivariate Cox proportional hazard analysis, the non-TNF-targeted treatment group had a lower likelihood of discontinuing their treatment than the second TNFi group [HR = 0.326, 95% confidence interval (CI): 0.170–0.626, p = 0.001]. When analyzed separately, the risk of discontinuation was significantly lower in both the non-TNFi biologic (HR = 0.318, 95% CI: 0.160–0.633, p = 0.001) and JAKi (HR = 0.356, 95% CI: 0.129–0.980, p = 0.046) groups than in the second TNFi group. Conclusion: Our study supported switching to a non-TNF-targeted treatment instead of TNF cycling in patients with RA showing an inadequate response to initial TNFi. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1759-7218 1759720X |
| Relation: | https://doaj.org/toc/1759-7218 |
| DOI: | 10.1177/1759720X221091450 |
| Access URL: | https://doaj.org/article/3d149b6be7a747fe804af97884f47ab1 |
| Accession Number: | edsdoj.3d149b6be7a747fe804af97884f47ab1 |
| Database: | Directory of Open Access Journals |
| ISSN: | 17597218 1759720X |
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| DOI: | 10.1177/1759720X221091450 |
| Published in: | Therapeutic Advances in Musculoskeletal Disease |
| Language: | English |