Patients with psoriatic arthritis who don’t respond to or cannot tolerate two different anti–tumor necrosis factor (TNF) agents are likely to respond poorly, if at all, to a third one, according to findings from a prospective, open-label, longitudinal study.
Dr. Lars Erik Kristensen of the department of rheumatology, Parker Institute, Copenhagen, and the department of rheumatology, Lund (Sweden) University Hospital, and his coinvestigators assessed treatment responses in patients treated at 11 European rheumatology centers during a 9-year period to build on the “rather sparse” data concerning second or third courses of anti-TNF treatment in psoriatic arthritis patients. “Our results suggest that other therapeutic options be considered after two courses of anti-TNF treatment have failed,” such as biological disease-modifying antirheumatic drugs that have different modes of action, they wrote.
The study participants were 217 patients with psoriatic arthritis who were switching from one anti-TNF agent to another and 57 who had tried two anti-TNF agents and were switching to a third. The drugs included etanercept, adalimumab, certolizumab pegol, golimumab, and infliximab.
In general, the treatment response rates among patients trying their second agent were markedly greater than those of patients trying their third. Nearly half (47%) of first-time switchers met the primary outcome measure – an ACR 20 response at 3 months – compared with only 22% of second-time switchers, the investigators said (J Rheumatol. 2015 Dec 1. doi: 10.3899/jrheum.150744).
The median drug survival (time on treatment) was 64 months for the first group, compared with only 14 months for the second group. The estimated 5-year drug survival was 51% for patients trying their second anti-TNF agent, compared with only 23% for patients trying their third.
This study was supported by the Osterlund Foundation, the Kock Foundation, the King Gustav V 80-Year Fund, Lund University Hospital, the Reumatikerforbundet, and the Oak Foundation. No information was available regarding Dr. Kristensen’s and his associates’ financial disclosures.