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Rheumatology Advance Access originally published online on February 27, 2008
Rheumatology 2008 47(4):507-513; doi:10.1093/rheumatology/ken034
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Treatment response to a second or third TNF-inhibitor in RA: results from the South Swedish Arthritis Treatment Group Register

J. A. Karlsson, L. E. Kristensen, M. C. Kapetanovic, A. Gülfe, T. Saxne and P. Geborek

Department of Rheumatology, Lund University Hospital, SE 221 85 Lund, Sweden.

Correspondence to: P. Geborek, Department of Rheumatology, Lund University Hospital, SE 221 85 Lund, Sweden. E-mail: pierre.geborek{at}med.lu.se


  Abstract

Objectives. To study treatment response rates of RA patients undergoing second- and third-line anti-TNF therapy and to identify baseline predictors of response to second-line treatment.

Methods. RA patients monitored in a prospective, observational study, having switched anti-TNF therapy once (first-time switchers, n = 337) or twice (second-time switchers, n = 36)—i.e. following failures with one antibody- and one receptor-type agent—between March 1999 and December 2006, were studied. Treatment responses at 3 months were assessed by the ACR and European League Against Rheumatism (EULAR) response criteria. Predictive potentials for response to second-line treatment of demographics, baseline disease activity measures, disease and treatment characteristics were analysed using logistic regression.

Results. ACR20 response was met by 51% of first-time and 35% of second-time switchers. Corresponding ACR50 rates were 27 and 18%; EULAR overall rates (EULAR good or moderate response) 71 and 58%; EULAR good rates 25 and 9% and 28-joint disease activity score (DAS28) remission rates 16 and 6%. Identified baseline predictors of response to second-line treatment were lower age and HAQ scores, elevated DAS28 values and having ceased the former anti-TNF treatment due to adverse events rather than inefficacy. No variable was predictive for all examined response criteria.

Conclusions. Response rates of first-time anti-TNF switchers are somewhat below those of anti-TNF naïve RA patients, while the markedly inferior response rates of second-time switchers suggest other therapeutic options to be considered in this situation. Identified baseline predictors of response may be useful indicators to second-line anti-TNF therapy, but vary depending on the response criteria set studied.

KEY WORDS: RA, Anti-TNF, Switching, Predictors, Observational study

Submitted 29 August 2007; revised version accepted 14 January 2008.
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