Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy.
Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy.
Semin Arthritis Rheum. 2017 Oct;47(2):183-192. doi: 10.1016/j.semarthrit.2017.03.008. Epub 2017 Mar 22.
The Italian board for the TAilored BIOlogic therapy (ITABIO) reviewed the most consistent literature to indicate the best strategy for the second-line biologic choice in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA).
Systematic review of the literature to identify English-language articles on efficacy of second-line biologic choice in RA, PsA, and ankylosing spondylitis (AS). Data were extracted from available randomized, controlled trials, national biologic registries, national healthcare databases, post-marketing surveys, and open-label observational studies.
Some previously stated variables, including the patients׳ preference, the indication for anti-tumor necrosis factor (TNF) monotherapy in potential childbearing women, and the intravenous route with dose titration in obese subjects resulted valid for all the three rheumatic conditions. In RA, golimumab as second-line biologic has the highest level of evidence in anti-TNF failure. The switching strategy is preferable for responder patients who experience an adverse event, whereas serious or class-specific side effects should be managed by the choice of a differently targeted drug. Secondary inadequate response to etanercept (ETN) should be treated with a biologic agent other than anti-TNF. After two or more anti-TNF failures, the swapping to a different mode of action is recommended. Among non-anti-TNF targeted biologics, to date rituximab (RTX) and tocilizumab (TCZ) have the strongest evidence of efficacy in the treatment of anti-TNF failures. In PsA and AS patients failing the first anti-TNF, the switch strategy to a second is advisable, taking in account the evidence of adalimumab efficacy in patients with uveitis. The severity of psoriasis, of articular involvement, and the predominance of enthesitis and/or dactylitis may drive the choice toward ustekinumab or secukinumab in PsA, and the latter in AS.
Taking in account the paucity of controlled trials, second-line biologic therapy may be reasonably optimized in patients with RA, SpA, and PsA.
意大利 TAilored BIOlogic therapy（ITABIO）委员会回顾了最一致的文献，以指出类风湿关节炎（RA）、脊柱关节炎（SpA）和银屑病关节炎（PsA）患者二线生物制剂选择的最佳策略。
系统地检索文献，以确定关于 RA、PsA 和强直性脊柱炎（AS）二线生物制剂选择疗效的英文文章。从可用的随机对照试验、国家生物制剂登记处、国家医疗保健数据库、上市后调查和开放性观察性研究中提取数据。
一些先前陈述的变量，包括患者的偏好、潜在生育期女性抗肿瘤坏死因子（TNF）单药治疗的适应证、肥胖患者的静脉途径和剂量滴定，对于所有三种风湿疾病均有效。在 RA 中，戈利木单抗作为二线生物制剂在抗 TNF 失败方面具有最高水平的证据。对于出现不良反应的应答患者，转换策略更为可取，而严重或特定于类别的副作用应通过选择不同靶向药物来管理。对依那西普（ETN）的继发性治疗反应不足应使用抗 TNF 以外的生物制剂进行治疗。在两种或更多种抗 TNF 失败后，建议采用不同作用模式的药物进行交换。在非抗 TNF 靶向生物制剂中，迄今为止，利妥昔单抗（RTX）和托珠单抗（TCZ）在治疗抗 TNF 失败方面具有最强的疗效证据。在首种抗 TNF 治疗失败的 PsA 和 AS 患者中，考虑到阿达木单抗在葡萄膜炎患者中的疗效证据，建议采用二线药物进行转换策略。银屑病的严重程度、关节受累程度、附着点炎和/或指（趾）炎的优势可能促使在 PsA 中选择乌司奴单抗或司库奇尤单抗，而在 AS 中选择后者。
考虑到对照试验的缺乏，RA、SpA 和 PsA 患者的二线生物治疗可以合理优化。
