Bogas Patricia, Plasencia-Rodriguez Chamaida, Navarro-Compán Victoria, Tornero Carolina, Novella-Navarro Marta, Nuño Laura, Martínez-Feito Ana, Hernández-Breijo Borja, Balsa Alejandro
Department of Rheumatology, La Paz University Hospital, 28046 Madrid, Spain.
Department of Rheumatology, La Paz University Hospital, Madrid, Spain.
Ther Adv Musculoskelet Dis. 2021 Nov 24;13:1759720X211060910. doi: 10.1177/1759720X211060910. eCollection 2021.
Currently, there is contradictory evidence regarding the best strategy to follow after discontinuation of a first biological agent in patients with rheumatoid arthritis (RA). We aimed to compare the long-term efficacy of switching to a second tumor necrosis factor inhibitor (TNFi) biopharmaceuticals with other mechanisms of action (non-TNFi) in patients with RA who previously failed a first TNFi.
This prospective cohort study analyzed data from 127 patients who discontinued a previous TNFi between 1999 and 2016. Disease activity was assessed at baseline and at 6, 12, and 24 months (m-6, m-12, m-24) after switching. Primary outcome was the proportion of patients achieving good/moderate EULAR response (E-resp). Factors associated with clinical outcomes were assessed using univariate and multivariate logistic regression models.
Seventy-seven (61%) patients received a second TNFi and 50 (39%) switched to a non-TNFi. At m-6 and m-12, no differences were observed between groups; nevertheless, at m-24, the proportion of patients with E-resp was higher in the non-TNFi group (49% TNFi group 77% non-TNFi group; = 0.002). In regression models, switching to a non-TNFi was significantly associated with E-resp at m-24 (odds ratio = 3.21; = 0.01). When assessing the response to the second biological agent based on the reason for discontinuation of the first TNFi, similar results were obtained; at m-24, patients who discontinued the first TNFi due to inefficacy (either primary or secondary) experienced a better E-resp if they had switched to a non-TNFi (primary inefficacy: 52% TNFi group 79% non-TNFi group, = 0.09; secondary inefficacy: 50% 76%, = 0.03).
In our cohort of RA patients who discontinued a first TNFi, those who switched to a non-TNFi were three times more likely to attain a sustained clinical response, regardless of whether they had discontinued the first biologic due to a primary or secondary inefficacy.
目前，关于类风湿关节炎（RA）患者停用第一种生物制剂后最佳治疗策略的证据相互矛盾。我们旨在比较在先前使用第一种肿瘤坏死因子抑制剂（TNFi）治疗失败的RA患者中，换用第二种TNFi生物制剂与换用其他作用机制的生物制剂（非TNFi）的长期疗效。
这项前瞻性队列研究分析了1999年至2016年间停用先前TNFi的127例患者的数据。在换药后的基线、6个月、12个月和24个月（m-6、m-12、m-24）评估疾病活动度。主要结局是达到良好/中度欧洲抗风湿病联盟反应（E-resp）的患者比例。使用单因素和多因素逻辑回归模型评估与临床结局相关的因素。
77例（61%）患者接受了第二种TNFi，50例（39%）换用了非TNFi。在m-6和m-12时，两组之间未观察到差异；然而，在m-24时，非TNFi组达到E-resp的患者比例更高（TNFi组为49%，非TNFi组为77%；P = 0.002）。在回归模型中，换用非TNFi与m-24时的E-resp显著相关（比值比 = 3.21；P = 0.01）。当根据停用第一种TNFi的原因评估对第二种生物制剂的反应时，得到了类似的结果；在m-24时，因无效（原发性或继发性）而停用第一种TNFi的患者，如果换用非TNFi，其E-resp更好（原发性无效：TNFi组为52%，非TNFi组为79%，P = 0.09；继发性无效：50%对76%，P = 0.03）。
在我们这个停用第一种TNFi的RA患者队列中，换用非TNFi的患者获得持续临床反应的可能性是换用TNFi患者的三倍，无论他们是因原发性还是继发性无效而停用第一种生物制剂。
