PMID- 27000865
OWN - NLM
STAT- MEDLINE
DCOM- 20161025
LR  - 20181113
IS  - 1478-6362 (Electronic)
IS  - 1478-6354 (Print)
IS  - 1478-6354 (Linking)
VI  - 18
DP  - 2016 Mar 22
TI  - Does the reason for discontinuation of a first TNF inhibitor influence the 
      effectiveness of a second TNF inhibitor in axial spondyloarthritis? Results from 
      the Swiss Clinical Quality Management Cohort.
PG  - 71
LID - 10.1186/s13075-016-0969-2 [doi]
LID - 71
AB  - BACKGROUND: With regard to switching tumor necrosis factor inhibitors (TNFi) in 
      axial spondyloarthritis (axSpA), conflicting results have been reported as to 
      whether the effectiveness of a second TNFi depends on the reason for 
      discontinuation of the first TNFi. METHODS: Patients with a clinical diagnosis of 
      axSpA starting a second TNFi in the Swiss Clinical Quality Management cohort were 
      included. Effectiveness of treatment at 1 year, as well as drug survival, was 
      compared between subgroups having discontinued the first TNFi because of lack of 
      response, adverse events (AEs), or other reasons. Lack of response was further 
      divided into primary or secondary lack of response (PLR or SLR, respectively), 
      depending on whether the first TNFi was stopped before or after 6 months of 
      treatment. RESULTS: Among 632 patients with axSpA, median survival of a second 
      TNFi was 1.1 years after PLR and 3.8 years after SLR (p = 0.003). At least 
      moderate disease activity as defined by an Ankylosing Spondylitis Disease 
      Activity Score using the erythrocyte sedimentation rate (ASDAS-ESR) <2.1 was 
      achieved after 12 months by 11 %, 39 %, 26 %, and 39 % of patients who 
      discontinued their first TNFi because of PLR, SLR, AEs, and other reasons, 
      respectively (p = 0.01). Only 4 % of patients achieved an ASDAS-ESR inactive 
      disease state after PLR, in comparison to 22 % of those after SLR. Similar 
      results were demonstrated in patients fulfilling the Assessment of 
      SpondyloArthritis international Society classification criteria for axSpA 
      (n = 488): ASDAS-ESR <2.1 was achieved after 12 months by 9 %, 41 %, 29 %, and 
      39 % of patients who discontinued their first TNFi because of PLR, SLR, AEs, and 
      other reasons, respectively (p = 0.01). CONCLUSIONS: The effectiveness of a 
      second TNFi is significantly impaired in patients with axSpA after PLR to a first 
      TNFi compared with SLR.
FAU - Ciurea, Adrian
AU  - Ciurea A
AD  - Department of Rheumatology, University Hospital Zurich, Gloriastrasse 25, 
      CH-8091, Zurich, Switzerland. adrian.ciurea@usz.ch.
FAU - Exer, Pascale
AU  - Exer P
AD  - Private Rheumatology Practice, Basel, Switzerland.
FAU - Weber, Ulrich
AU  - Weber U
AD  - King Christian 10th Hospital for Rheumatic Diseases, Grasten, Denmark.
AD  - South Jutland Hospital, Denmark Institute of Regional Health Research, University 
      of Southern Denmark, Odense, Denmark.
FAU - Tamborrini, Giorgio
AU  - Tamborrini G
AD  - Department of Rheumatology, Bethesda Hospital, Basel, Switzerland.
FAU - Steininger, Beate
AU  - Steininger B
AD  - Department of Rheumatology, University Hospital Zurich, Gloriastrasse 25, 
      CH-8091, Zurich, Switzerland.
FAU - Kissling, Rudolf O
AU  - Kissling RO
AD  - Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland.
FAU - Bernhard, Jurg
AU  - Bernhard J
AD  - Department of Rheumatology and Rehabilitation, Burgerspital, Solothurn, 
      Switzerland.
FAU - Scherer, Almut
AU  - Scherer A
AD  - Swiss Clinical Quality Management Foundation, Zurich, Switzerland.
CN  - Rheumatologists of Swiss Clinical Quality Management Program for Axial 
      Spondyloarthritis
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160322
PL  - England
TA  - Arthritis Res Ther
JT  - Arthritis research & therapy
JID - 101154438
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Adult
MH  - Antirheumatic Agents/*therapeutic use
MH  - Cohort Studies
MH  - *Drug Substitution
MH  - Female
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Spondylitis, Ankylosing/*drug therapy
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors
PMC - PMC4802885
OTO - NOTNLM
OT  - Axial spondyloarthritis
OT  - Drug retention
OT  - Switching
OT  - Tumor necrosis factor inhibitors
EDAT- 2015/01/01 00:00
MHDA- 2016/10/26 06:00
PMCR- 2016/03/22
CRDT- 2016/03/23 06:00
PHST- 2016/01/19 00:00 [received]
PHST- 2016/03/10 00:00 [accepted]
PHST- 2016/03/23 06:00 [entrez]
PHST- 2015/01/01 00:00 [pubmed]
PHST- 2016/10/26 06:00 [medline]
PHST- 2016/03/22 00:00 [pmc-release]
AID - 10.1186/s13075-016-0969-2 [pii]
AID - 969 [pii]
AID - 10.1186/s13075-016-0969-2 [doi]
PST - epublish
SO  - Arthritis Res Ther. 2016 Mar 22;18:71. doi: 10.1186/s13075-016-0969-2.