Second bDMARD after failure of non-TNFi biologic in RA shows modest drug survival, response

A recent study has shown modest drug survival and primary response of a second biologic disease-modifying antirheumatic drug (bDMARD) in patients with rheumatoid arthritis (RA) switching due to failure of a nontumour necrosis factor inhibitor (non-TNFi) bDMARD as the first agent.

“In RA, evidence regarding the effectiveness of a second bDMARD in patients whose first-ever bDMARD was a non-TNFi bDMARD is limited,” according to the authors, who then set out to examine the outcome of a second bDMARD (non-TNFi: rituximab, abatacept, or tocilizumab, separately; and TNFi) after failure of a non-TNFi bDMARD as first agent.

Patients with RA, who initiated treatment with a non-TNFi asf first bDMARD but switched to a second one, were identified from five Nordic biologics registers. The authors then assessed drug survival at 6 and 12 months and primary response at 6 months for the second bDMARD.

Of the 610 patients starting a second bDMARD after failure of a first non-TNFi bDMARD, 86 used abatacept, 40 rituximab, 67 tocilizumab, and 427 TNFi.

About 70 percent and 60 percent remained on treatment at 6 and 12 months, respectively, after start of the second bDMARD. At 6 months, less than one-third of patients remained on their second bDMARD and had reached low disease activity or remission according to the Disease Activity Score in 28 joints. Notably, the corresponding proportion for those whose second bDMARD was a TNFi was slightly higher at 40 percent.

“Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD,” the authors said.