BIRMINGHAM, ENGLAND — Nearly half of all patients who initially failed therapy with anti-tumor necrosis factor-α agents benefited following a switch to a second or third drug in the class, according to a study presented at the annual meeting of the British Society for Rheumatology.
Dr. Jemma Pringle and associates studied 153 rheumatology patients who had a mean disease duration of 12 years upon entrance to a registry between 2001 and 2006. The patients' median initial disease activity score (DAS) was 7.55.
A cohort of 53 patients stopped their initial anti-TNF-α agent. Of these, 23 stopped due to an adverse event and 30 from loss of efficacy. Of the 33 who received a second anti-TNF-α agent, 22 responded and have remained on the drug for a median of 19 months at the time of her presentation, Dr. Pringle said.
The other 11 stopped anti-TNF-α therapy because of side effects and/or a lack of efficacy. Patients experienced a mean decrease in DAS of 32% from baseline to 4.15 after they undertook treatment with an alternative anti-TNF-α agent.
Of the seven participants who eventually switched to a third drug, four responded and continued to take the drug for a median of 6 months. There was a 44% mean decrease in baseline DAS among these patients.
“Nearly half of these are presently continuing their second or third agent with a clinically significant response,” said Dr. Pringle, a rheumatologist at Gartnavel General Hospital, Glasgow, Scotland.
Up to 40% of patients do not respond to their initial anti-TNF-α drug, commented Dr. Pringle.
However, because each of the different anti-TNF-α agents have different properties, Dr. Pringle advised sticking with the class before considering other therapies, despite the fact that switching patients to a second anti-TNF-α agent is not as cost effective (since second response rates are lower), as one meeting attendee pointed out.