%0 Journal Article %A Katerina Chatzidionysiou %A Merete Lund Hetland %A Thomas Frisell %A Daniela Di Giuseppe %A Karin Hellgren %A Bente Glintborg %A Dan Nordström %A Ritva Peltomaa %A Kalle Aaltonen %A Nina Trokovic %A Eirik K. Kristianslund %A Tore K. Kvien %A Sella A. Provan %A Bjorn Gudbjornsson %A Gerdur Grondal %A Lene Dreyer %A Lars Erik Kristensen %A Tanja Schjødt Jørgensen %A Lennart T.H. Jacobsson %A Johan Askling %T Effectiveness of a Second Biologic After Failure of a Non–tumor Necrosis Factor Inhibitor As First Biologic in Rheumatoid Arthritis %D 2021 %R 10.3899/jrheum.201467 %J The Journal of Rheumatology %P jrheum.201467 %X Objective In rheumatoid arthritis (RA), evidence regarding the effectiveness of a second biologic disease- modifying antirheumatic drug (bDMARD) in patients whose first-ever bDMARD was a non–tumor necrosis factor inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of a second bDMARD (non-TNFi: rituximab [RTX], abatacept [ABA], or tocilizumab [TCZ], separately; and TNFi) after failure of a non-TNFi bDMARD as first bDMARD. Methods We identified patients with RA from the 5 Nordic biologics registers who started treatment with a non-TNFi as first-ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed drug survival (at 6 and 12 months) and primary response (at 6 months). Results We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67, and TNFi 427) following failure of a first non-TNFi bDMARD. At 6 and 12 months after start of their second bDMARD, approximately 70% and 60%, respectively, remained on treatment, and at 6 months, less than one-third of patients were still on their second bDMARD and had reached low disease activity or remission according to the Disease Activity Score in 28 joints. For those patients whose second bMDARD was a TNFi, the corresponding proportion was slightly higher (40%). Conclusion The drug survival and primary response of a second bDMARD in patients with RA switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD. %U https://www.jrheum.org/content/jrheum/early/2021/07/25/jrheum.201467.full.pdf