Strasbourg, France—As many as one-third of rheumatoid arthritis patients have persistent disease activity and insufficient response after being prescribed antitumor necrosis factor (TNF) biologic agents. Yet, little consensus exists on how to select the best next treatment.

Now, a new study published in the Journal of the American Medical Association reports that a non-TNF biologic agent was found to be more effective in achieving a good or moderate disease activity response at 24 weeks than a second anti-TNF medication.

In general, the Universite de Strasbourg–led research points out, tumor necrosis factor alpha (TNF-alpha) inhibitors have improved the quality of life for most rheumatoid arthritis patients who show insufficient response to the agent methotrexate. 

For the study, researchers randomly assigned 300 rheumatoid arthritis patients with persistent disease activity and an insufficient response to anti-TNF therapy to receive a non-TNF-targeted biologic agent or an anti-TNF different from their previous treatment.

The treating clinician determined which biologic to prescribe within each randomized group. Researchers explained that the primary strength of the study was its “pragmatic design. Physicians commonly choose one drug rather than another for multiple reasons (habits, characteristics of patients). We chose to compare strategies instead of individual drug prescriptions because this issue corresponds to the therapeutic question clnicians face in daily practice.”

With 269 patients completing the study overall, at week 24, 101 of 146 patients (69%) in the non-TNF group and 76 (52%) in the second anti-TNF group achieved a good or moderate response, according to the results. The participants were 83.2% female with an average age of 57.1.

Over time, more patients in the non-TNF group versus the second anti-TNF group showed low disease activity—45% versus 28% at week 24; and 41% versus 23% at week 52, respectively. 

“Among patients with rheumatoid arthritis previously treated with anti-TNF drugs but considered for a second medication due to inadequate primary response, a non-TNF biologic agent was more effective in achieving a good or moderate disease activity response at 24 weeks,” study authors conclude. “However, a second anti-TNF drug to treat these patients was often effective in producing a clinical improvement.”

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