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Research ArticleArticle

Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden

Lars Erik Kristensen, Elisabeth Lie, Lennart T.H. Jacobsson, Robin Christensen, Philip J. Mease, Henning Bliddal and Pierre Geborek
The Journal of Rheumatology January 2016, 43 (1) 81-87; DOI: https://doi.org/10.3899/jrheum.150744
Lars Erik Kristensen
From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.
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  • For correspondence: Larserik_kristensen@yahoo.com
Elisabeth Lie
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Lennart T.H. Jacobsson
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Robin Christensen
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Philip J. Mease
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Henning Bliddal
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Pierre Geborek
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Abstract

Objective. Because new modes of action for the treatment of psoriatic arthritis (PsA) are emerging, it is important to understand the use of switching to a second or third antitumor necrosis factor (anti-TNF) agent. This study investigated drug survival and treatment response rates of patients with PsA undergoing second- and third-line anti-TNF therapy.

Methods. Patients with PsA were monitored in a prospective, observational study. Patients who switched anti-TNF therapy once (first-time switchers, n = 217) or twice (second-time switchers, n = 57) between January 2003 and March 2012 were studied. American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) good response at 3 and 6 months, as well as drug survival, were reported and further analyzed using the Cox and logistic regression models.

Results. Median age for first-time switchers was 47 years and 42% were men. The corresponding values for second-time switchers were 48 years and 40% men. Three-month ACR20 Lund Efficacy Index (LUNDEX) response was achieved by 47% of first-time and 22% of second-time switchers; ACR50 LUNDEX rates were 21% and 14%, ACR70 LUNDEX rates were 12% and 2%, and EULAR good LUNDEX rates were 26% and 10%, respectively. Median drug survival time for patients switching anti-TNF for the first time was 64 months (95% CI 31–97) compared with 14 months (95% CI 5–23) for second-time switchers. Identified baseline predictor of ACR20 response to second-line treatment was the 28-joint Disease Activity Score values at baseline (OR 1.45, 95% CI 1.01–2.10), while higher Health Assessment Questionnaire scores predicted premature drug withdrawal (HR 1.60, 95% CI 1.03–2.48).

Conclusion. Response rates of first-time anti-TNF switchers are moderate, while the inferior response rates of second-time switchers suggest other therapeutic options should be considered in this situation.

Key Indexing Terms:
  • PSORIATIC ARTHRITIS
  • ANTI-TUMOR NECROSIS FACTOR
  • SWITCHING
  • PREDICTORS
  • OBSERVATIONAL STUDY

Footnotes

  • Supported by grants from Österlund and Kock Foundations, King Gustav V 80-year fund, Lund University Hospital Funds, and Reumatikerförbundet. LEK, RC, and HB are sponsored by the Oak Foundation.

  • Accepted for publication September 22, 2015.
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1 Jan 2016
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Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden
Lars Erik Kristensen, Elisabeth Lie, Lennart T.H. Jacobsson, Robin Christensen, Philip J. Mease, Henning Bliddal, Pierre Geborek
The Journal of Rheumatology Jan 2016, 43 (1) 81-87; DOI: 10.3899/jrheum.150744

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Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden
Lars Erik Kristensen, Elisabeth Lie, Lennart T.H. Jacobsson, Robin Christensen, Philip J. Mease, Henning Bliddal, Pierre Geborek
The Journal of Rheumatology Jan 2016, 43 (1) 81-87; DOI: 10.3899/jrheum.150744
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Keywords

PSORIATIC ARTHRITIS
ANTI-TUMOR NECROSIS FACTOR
SWITCHING
PREDICTORS
OBSERVATIONAL STUDY

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Keywords

  • psoriatic arthritis
  • ANTI-TUMOR NECROSIS FACTOR
  • SWITCHING
  • PREDICTORS
  • OBSERVATIONAL STUDY

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