Switching TNF Therapies Affects Response in Ankylosing Spondylitis


Data from a national registry of ankylosing spondylitis reveal that patients not finding relief from one THF inhibitor usually benefit from trying a different one.

Glintborg B, stergaard M, Krogh NS et alExtended report: Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registryAnn Rheum Dis (2013) 72:1149-1155


According to a retrospective study from Denmark, almost one-third of ankylosing spondylitis (AS) patients switch from their first tumor necrosis factor inhibitor (TNFi) drug at least once during routine care over a 10 year period, mostly due to drug inefficacy.

The study of 1,432 TNFi-nave AS patients in a national registry found that 432 changed to a second and third TNFi. The most frequent switchers were women and patients with shorter disease duration (3 to 5 years), high baseline subjective disease activity, and previous treatment with methotrexate.

Half of patients switched TNFi’s due to lack of treatment effect and one in four due to adverse events.
Although the drug switchers appeared to have worse “drug survival” (treatment response and duration) with a particular TNFi than non-switchers, approximately half of those who changed did achieve a clinical response. Disease activity decreased significantly during the second and third treatment course.

Infliximab was the most frequent first-line TNFi from 2001 to 2008 and adalimumab from 2009 to 2010, but researchers found no differences in overall efficacy.

The researchers conclude that -- irrespective of reasons for stopping the first drug -- if one TNFi isn't working satisfactorily in AS, it's worth considering a change to another.

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