Department of Clinical Science and Community Health, University of Milan, Milan, Italy.
Department of Rheumatology, ASST Pini-CTO, Milan, Italy.
Mod Rheumatol. 2023 Dec 22;34(1):11-26. doi: 10.1093/mr/road033.
The emergence of biologics with different modes of action (MoAs) and therapeutic targets has changed treatment patterns in patients with inflammatory rheumatic diseases. While tumour necrosis factor inhibitors (TNFis) are often utilized as the first biologic disease-modifying antirheumatic drug, some patients may not respond adequately (primary failure), fail to sustain response over time (secondary failure), or experience intolerable adverse events. Whether these patients would benefit more from cycling to a different TNFi or switching to a biologic with a different MoA is still unclear. We discuss here treatment outcomes of TNFi cycling versus MoA switching after treatment failure with a first TNFi in patients with inflammatory rheumatic diseases, focusing specifically on rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis. Treatment guidelines for these patients are ambiguous and, at times, contradictory in their recommendations. However, this is due to a lack of high-quality head-to-head data to definitively support cycling between TNFis after failure to a first-line TNFi over switching to a different MoA.
生物制剂具有不同的作用机制（MoA）和治疗靶点，这改变了炎症性风湿病患者的治疗模式。肿瘤坏死因子抑制剂（TNFis）通常被用作一线生物疾病修饰抗风湿药物，但有些患者可能无法充分应答（原发性失效）、无法随着时间的推移维持应答（继发性失效）或出现无法耐受的不良反应。这些患者是否从循环使用另一种 TNFis 或切换到具有不同 MoA 的生物制剂中获益更多，目前仍不清楚。我们在此讨论炎症性风湿病患者使用一线 TNFis 治疗失败后，TNFis 循环与 MoA 切换的治疗结局，重点关注类风湿关节炎、银屑病关节炎、中轴型脊柱关节炎和幼年特发性关节炎。这些患者的治疗指南并不明确，有时相互矛盾。然而，这是由于缺乏高质量的头对头数据来明确支持在一线 TNFis 治疗失败后进行 TNFis 之间的循环，而不是切换到不同的 MoA。
