title: DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists.
abstract: BACKGROUND
  No definitive data are available regarding the value of switching to an alternative TNF antagonist in rheumatoid arthritis patients who fail to respond to the first one. The aim of this study was to evaluate treatment response in a clinical setting based on HAQ improvement and EULAR response criteria in RA patients who were switched to a second or a third TNF antagonist due to failure with the first one.
  
  
  METHODS
  This was an observational, prospective study of a cohort of 417 RA patients treated with TNF antagonists in three university hospitals in Spain between January 1999 and December 2005. A database was created at the participating centres, with well-defined operational instructions. The main outcome variables were analyzed using parametric or non-parametric tests depending on the level of measurement and distribution of each variable.
  
  
  RESULTS
  Mean (+/- SD) DAS-28 on starting the first, second and third TNF antagonist was 5.9 (+/- 2.0), 5.1 (+/- 1.5) and 6.1 (+/- 1.1). At the end of follow-up, it decreased to 3.3 (+/- 1.6; Delta = -2.6; p > 0.0001), 4.2 (+/- 1.5; Delta = -1.1; p = 0.0001) and 5.4 (+/- 1.7; Delta = -0.7; p = 0.06). For the first TNF antagonist, DAS-28-based EULAR response level was good in 42% and moderate in 33% of patients. The second TNF antagonist yielded a good response in 20% and no response in 53% of patients, while the third one yielded a good response in 28% and no response in 72%. Mean baseline HAQ on starting the first, second and third TNF antagonist was 1.61, 1.52 and 1.87, respectively. At the end of follow-up, it decreased to 1.12 (Delta = -0.49; p < 0.0001), 1.31 (Delta = -0.21, p = 0.004) and 1.75 (Delta = -0.12; p = 0.1), respectively. Sixty four percent of patients had a clinically important improvement in HAQ (defined as > or = -0.22) with the first TNF antagonist and 46% with the second.
  
  
  CONCLUSIONS
  A clinically significant effect size was seen in less than half of RA patients cycling to a second TNF antagonist.
authors.affiliation: Rheumatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain. federico.navarro.sspa@juntadeandalucia.es
authors.forename: Federico
authors.initials: F
authors.lastname: Navarro-Sarabia
authors.forename: Dolores
authors.initials: D
authors.lastname: Ruiz-Montesinos
authors.forename: Blanca
authors.initials: B
authors.lastname: Hernandez
authors.forename: Victoria
authors.initials: V
authors.lastname: Navarro-Compán
authors.forename: Sara
authors.initials: S
authors.lastname: Marsal
authors.forename: Mireia
authors.initials: M
authors.lastname: Barcelo
authors.forename: Eva
authors.initials: E
authors.lastname: Perez-Pampín
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Gómez-Reino
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D019992:Databases as Topic; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013030:Spain; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha