title: Switching tumour necrosis factor alpha antagonists in patients with ankylosing spondylitis and psoriatic arthritis: an observational study over a 5-year period.
abstract: OBJECTIVE
  To evaluate the clinical response after switching from one tumour necrosis factor (TNF)alpha antagonist to another in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).
  
  
  METHODS
  In this ongoing, longitudinal, observational study, data were prospectively collected on efficacy and safety since 2000 for patients starting biological treatments. The present analysis was restricted to patients with a diagnosis of spondyloarthropathy (SpA) who switched from one TNFalpha antagonist to another because of inadequate efficacy or adverse events.
  
  
  RESULTS
  In total, 589 anti-TNFalpha-naive patients were registered, of whom 165 had a diagnosis of SpA; 7 patients with AS and 15 with PsA received >1 TNFalpha antagonist. Two patients with PsA were treated with all the drugs. In all, 16 subjects switched from infliximab to etanercept, 7 from etanercept to adalimumab and 1 from etanercept to infliximab. Overall, a clinical response was seen in 75% of patients who changed from infliximab to etanercept, and in 57.1% who switched from etanercept to adalimumab.
  
  
  CONCLUSIONS
  The findings of this study on a selected population of patients with SpA indicate that the failure of an initial TNFalpha antagonist does not preclude the response to another one. Further trials are needed to confirm this preliminary observation.
authors.affiliation: Dipartimento di Clinica e Terapia Medica, Sezione di Reumatologia, Sapienza Università di Roma, Policlinico Umberto I, Roma, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Conti
authors.forename: Fulvia
authors.initials: F
authors.lastname: Ceccarelli
authors.forename: Elisa
authors.initials: E
authors.lastname: Marocchi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Magrini
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Spinelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadaro
authors.forename: Rossana
authors.initials: R
authors.lastname: Scrivo
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept