September 26, 2016
2 min read

As second-line therapy for RA, non-TNF drugs were more effective than anti-TNF drugs for some patients

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As a second-line therapy for a specific subgroup of patients with rheumatoid arthritis, non-tumor necrosis factor drugs were more effective than anti-tumor necrosis factor drugs, according to recently published results from a clinical trial.

“This is the first randomized trial that compared a second [anti-tumor necrosis factor] anti-TNF to a non-TNF targeted biologic in patients with rheumatoid arthritis and insufficient response to a first anti-TNF,” Jacques-Eric Gottenberg, MD, PhD, in the Department of Rheumatology at the University of Strasbourg in France, told “Previously, only observational studies were available for an issue that rheumatologists face every day in their common practice.”

Jacques-Eric Gottenberg

Currently, one-third of patients with rheumatoid arthritis (RA) have an inadequate response to anti-TNF drugs, the researchers wrote. Despite this, there is no official guidance for choosing second-line treatment.

To compare the efficacy of non-TNF and anti-TNF drugs as second-line therapy, researchers performed a randomized clinical trial of 300 patients treated for RA for 52 weeks between 2009 and 2012. Patients had persistent disease activity, which was defined as a DAS28-erythrocyte sedimentation rate (DAS28-ESR) of at least 3.2, and an insufficient response to anti-TNF therapy. Follow-up occurred in 2013. Of the 269 patients who completed the study, most were female and the overall mean age was 57.1 years.

In the non-TNF group, 23% of patients received abatacept; 28% received rituximab; and 48% received tocilizumab. In the anti-TNF group, 39% of patients received adalimumab; 16% received certolizumab; 36% received etanercept; and 5% received infliximab.

The primary outcome was the proportion of patients with at least a moderate response to therapy at week 24, according to the EULAR scale. Secondary outcomes included EULAR response at weeks 12 and 52, as well as low disease activity, remission, serious adverse events and serious infections at weeks 12, 24 and 52.

The researchers found 69% of the non-TNF group and 52% of the anti-TNF group had at least a moderate response to therapy (odds ratio = 2.06). In addition, the DAS28-ESR was lower in the non-TNF group (mean difference, –0.43). At weeks 24 and 52, more patients in the non-TNF group showed low disease activity at both week 24 (45% vs. 28%) and week 52 (41% vs. 23%).

“The study demonstrates a superior effectiveness of a non-TNF targeted biologic (abatacept, rituximab or tocilizumab) over second anti-TNF,” Gottenberg said. “The results provide guidance for the therapeutic strategy choice in patients with rheumatoid arthritis and insufficient response to a first anti-TNF.” – by Will Offit

Disclosures: Gottenberg reports grant support from AbbVie, Pfizer and Roche and personal fees from Bristol-Myers Squibb, Merck, Sharp and Dohme, UCB, GlaxoSmithKline and Novartis. Please see the full study for all other authors’ relevant financial disclosures.