Recent Developments in Anti-TNF Therapy for Rheumatoid Arthritis

974, Glass RJ et al.10 Key Point Patients treated with TNF inhibitors remain on therapy long term, suggesting durable effects and tolerability. Anti-TNF Therapy in Biologic-Naïve and Experienced Patients Clinical trials of anti-TNF therapy typically excluded patients who had prior exposure to a TNF inhibitor. In clinical practice, clinicians often encounter patients with RA who have been treated with one or more agents in the anti-TNF class. The efficacy of TNF inhibitors in biologic-experienced patients with RA has not been studied extensively. Greenberg et al performed a retrospective analysis of data from an RA registry that included biologic-naïve and experienced patients.11 Methods Registry patients who had one or more prescriptions for a TNF inhibitor were stratified into three groups: biologic-naïve patients (1,395); first-switch patients (630); second-switched patients (163). The groups were compared with respect to response, remission, and persistency with anti-TNF therapy. Response was defined by modified ACR 20 (mACR 20) criteria and remission by a Clinical Disease Activity Index (CDAI) score <2.8. Because of limited sample size, outcomes for infliximab versus other TNF inhibitors involved only biologic-naïve and firstswitch patients. Investigators excluded patients who were in CDAI remission at baseline and those who discontinued antiTNF therapy because of toxicity. Results The persistency rate for biologic-naïve patients was 80.2% at 6 months, 67.5% at 12 months, and 52.8% at 24 months. Anti-TNF experienced patients had hazard ratios for discontinuation of 1.43 (first switch) and 1.42 (second switch) compared with biologic-naïve patients. Biologicnaïve patients were less likely to discontinue anti-TNF therapy with infliximab compared with the other anti-TNF agents (hazard ratio [HR] 0.74), but not firstswitch patients. Modified ACR 20 response rates for biologic-naïve patients were 29.7% at 6 months, 26.9% at 12 months, and 23% at 24 months. In contrast, first-switch patients had significantly lower mACR 20 response rates at 6 months (odds ratio [OR] 0.58), at 12 months (OR 0.50), and at 24 months (OR 0.51). Second-switch patients also had lower mACR 20 rates Exploring the Impact of Anti-TNF Switch Anti-TNF Treatment Category N Months DAS HAQ Fatigue Tx ongoing, 1 Anti-TNF 312 44 3.3 1.4 40 Tx ongoing, >1 Anti-TNF 109 46 3.7 1.4 53 Stopped After 1 Anti-TNF 72 21 4.1 1.5 44 Stopped After >1 Anti-TNF 39 31 4.5 1.2 51 DAS=Disease Activity Scale; HAQ=Health Assessment Questionnaire. Adapted from: Glass RJ et al.10 Table 4. Mean Outcomes: Anti-TNF Switch Versus No Switch 10 Recent Developments in Anti-TNF Therapy for Rheumatoid Arthritis UCB_RHU_0409.qxd:UCB_RHU_0409 3/19/09 4:10 PM Page 10