Study Compares Treatments Options for Patients with Rheumatoid Arthritis Following Inadequate Response to Anti-TNF Drug

Among patients with rheumatoid arthritis previously treated with anti-tumor necrosis factor (TNF) drugs but with insufficient response, a non-TNF biologic agent was more effective in achieving a good or moderate disease activity response at 24 weeks than was a second anti-TNF medication, according to a study appearing in the September 20 issue of JAMA.
 
Tumor necrosis factor α (TNF-α) inhibitors have improved the quality of life for patients with rheumatoid arthritis who show insufficient response to the agent methotrexate. However, as many as one-third of patients have persistent disease activity and insufficient response to anti-TNF agents, and there is little guidance on choosing the next treatment.
 
Jacques-Eric Gottenberg, M.D., Ph.D., of the Universite de Strasbourg, Strasbourg, France, and colleagues randomly assigned 300 patients with rheumatoid arthritis with persistent disease activity and an insufficient response to anti-TNF therapy to receive a non-TNF-targeted biologic agent or an anti-TNF that differed from their previous treatment. The choice of the biologic prescribed within each randomized group was left to the treating clinician.
 
Of the 300 randomized patients, 269 (90 percent) completed the study. At week 24, 101 of 146 patients (69 percent) in the non-TNF group and 76 (52 percent) in the second anti-TNF group achieved a good or moderate response. A measure of disease activity was lower in the non-TNF group than in the second anti-TNF group. At weeks 24 and 52, more patients in the non-TNF group vs the second anti-TNF group showed low disease activity (45 percent vs 28 percent at week 24; and 41 percent vs 23 percent at week 52).
 
“Among patients with rheumatoid arthritis previously treated with anti-TNF drugs but considered for a second medication due to inadequate primary response, a non-TNF biologic agent was more effective in achieving a good or moderate disease activity response at 24 weeks. However, a second anti-TNF drug to treat these patients was often effective in producing a clinical improvement,” the authors conclude.
 
(doi:10.1001/jama.2016.13512;