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Treatment response to a second or third TNF-inhibitor in RA: results from the South Swedish Arthritis Treatment Group Register.

Karlsson, JA LU ; Kristensen, Lars Erik LU ; C Kapetanovic, Meliha LU ; Gülfe, Anders LU ; Saxne, Tore LU and Geborek, Pierre LU (2008) In Rheumatology 47(4). p.507-513
Abstract
Objectives. To study treatment response rates of RA patients undergoing second- and third-line anti-TNF therapy and to identify baseline predictors of response to second-line treatment. Methods. RA patients monitored in a prospective, observational study, having switched anti-TNF therapy once (first-time switchers, n = 337) or twice (second-time switchers, n = 36)-i.e. following failures with one antibody- and one receptor-type agent-between March 1999 and December 2006, were studied. Treatment responses at 3 months were assessed by the ACR and European League Against Rheumatism (EULAR) response criteria. Predictive potentials for response to second-line treatment of demographics, baseline disease activity measures, disease and treatment... (More)
Objectives. To study treatment response rates of RA patients undergoing second- and third-line anti-TNF therapy and to identify baseline predictors of response to second-line treatment. Methods. RA patients monitored in a prospective, observational study, having switched anti-TNF therapy once (first-time switchers, n = 337) or twice (second-time switchers, n = 36)-i.e. following failures with one antibody- and one receptor-type agent-between March 1999 and December 2006, were studied. Treatment responses at 3 months were assessed by the ACR and European League Against Rheumatism (EULAR) response criteria. Predictive potentials for response to second-line treatment of demographics, baseline disease activity measures, disease and treatment characteristics were analysed using logistic regression. Results. ACR20 response was met by 51% of first-time and 35% of second-time switchers. Corresponding ACR50 rates were 27 and 18%; EULAR overall rates (EULAR good or moderate response) 71 and 58%; EULAR good rates 25 and 9% and 28-joint disease activity score (DAS28) remission rates 16 and 6%. Identified baseline predictors of response to second-line treatment were lower age and HAQ scores, elevated DAS28 values and having ceased the former anti-TNF treatment due to adverse events rather than inefficacy. No variable was predictive for all examined response criteria. Conclusions. Response rates of first-time anti-TNF switchers are somewhat below those of anti-TNF naïve RA patients, while the markedly inferior response rates of second-time switchers suggest other therapeutic options to be considered in this situation. Identified baseline predictors of response may be useful indicators to second-line anti-TNF therapy, but vary depending on the response criteria set studied. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
RA, Anti-TNF, Switching, Predictors, Observational study
in
Rheumatology
volume
47
issue
4
pages
507 - 513
publisher
Oxford University Press
external identifiers
  • pmid:18304941
  • wos:000255520300026
  • scopus:43049162899
ISSN
1462-0332
DOI
10.1093/rheumatology/ken034
language
English
LU publication?
yes
id
464e5a23-ff9d-4bf8-861d-254597834e08 (old id 1041443)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18304941?dopt=Abstract
date added to LUP
2008-03-06 11:52:30
date last changed
2017-11-05 04:13:57
@article{464e5a23-ff9d-4bf8-861d-254597834e08,
  abstract     = {Objectives. To study treatment response rates of RA patients undergoing second- and third-line anti-TNF therapy and to identify baseline predictors of response to second-line treatment. Methods. RA patients monitored in a prospective, observational study, having switched anti-TNF therapy once (first-time switchers, n = 337) or twice (second-time switchers, n = 36)-i.e. following failures with one antibody- and one receptor-type agent-between March 1999 and December 2006, were studied. Treatment responses at 3 months were assessed by the ACR and European League Against Rheumatism (EULAR) response criteria. Predictive potentials for response to second-line treatment of demographics, baseline disease activity measures, disease and treatment characteristics were analysed using logistic regression. Results. ACR20 response was met by 51% of first-time and 35% of second-time switchers. Corresponding ACR50 rates were 27 and 18%; EULAR overall rates (EULAR good or moderate response) 71 and 58%; EULAR good rates 25 and 9% and 28-joint disease activity score (DAS28) remission rates 16 and 6%. Identified baseline predictors of response to second-line treatment were lower age and HAQ scores, elevated DAS28 values and having ceased the former anti-TNF treatment due to adverse events rather than inefficacy. No variable was predictive for all examined response criteria. Conclusions. Response rates of first-time anti-TNF switchers are somewhat below those of anti-TNF naïve RA patients, while the markedly inferior response rates of second-time switchers suggest other therapeutic options to be considered in this situation. Identified baseline predictors of response may be useful indicators to second-line anti-TNF therapy, but vary depending on the response criteria set studied.},
  author       = {Karlsson, JA and Kristensen, Lars Erik and C Kapetanovic, Meliha and Gülfe, Anders and Saxne, Tore and Geborek, Pierre},
  issn         = {1462-0332},
  keyword      = {RA,Anti-TNF,Switching,Predictors,Observational study},
  language     = {eng},
  number       = {4},
  pages        = {507--513},
  publisher    = {Oxford University Press},
  series       = {Rheumatology},
  title        = {Treatment response to a second or third TNF-inhibitor in RA: results from the South Swedish Arthritis Treatment Group Register.},
  url          = {http://dx.doi.org/10.1093/rheumatology/ken034},
  volume       = {47},
  year         = {2008},
}