title: The reason for discontinuation of the first tumor necrosis factor (TNF) blocking agent does not influence the effect of a second TNF blocking agent in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate whether the reason for discontinuation of the first tumor necrosis factor (TNF) blocking agent influences the effect of a second TNF blocking agent.
  
  
  METHODS
  Data were used from 2 Dutch registries including patients with rheumatoid arthritis (RA) treated with TNF blocking agents. Patients were divided into 3 groups based on reason for discontinuation of the first: nonresponse, loss of response, or adverse events. The primary outcome was the change from baseline of the disease activity (by DAS28) at 6 months, corrected for the baseline DAS28 score. Secondary outcomes were the change from baseline at 3 months, EULAR response rates, and the percentages of patients who reached a DAS28 score < or = 3.2 at 3 and at 6 months.
  
  
  RESULTS
  In total, 49 patients who failed due to nonresponse, 75 due to loss of response, and 73 due to adverse events were included. At 6 months, the change of DAS28 score from baseline did not differ significantly between the groups (-0.6 to -1.3; p > or = 0.173) and similar good and moderate response rates were found (12% to 18%, p > or = 0.523, and 34% to 55%, p > or = 0.078, respectively). The secondary outcomes were also comparable between the 3 groups.
  
  
  CONCLUSIONS
  The results of our observational study suggest that a second TNF blocking agent may be effective after failure of the first, regardless of the reason for discontinuation of the first TNF blocking agent.
authors.affiliation: Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO Box 9101, H 470, 6500 HB Nijmegen, The Netherlands. m.blom@reuma.umcn.nl
authors.forename: Marlies
authors.initials: M
authors.lastname: Blom
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
authors.forename: Jaap
authors.initials: J
authors.lastname: Fransen
authors.forename: Ina H
authors.initials: IH
authors.lastname: Kuper
authors.forename: Alfons A
authors.initials: AA
authors.lastname: den Broeder
authors.forename: Carla M A
authors.initials: CM
authors.lastname: De Gendt
authors.forename: Tim L
authors.initials: TL
authors.lastname: Jansen
authors.forename: Herman L M
authors.initials: HL
authors.lastname: Brus
authors.forename: Mart A F J
authors.initials: MA
authors.lastname: van de Laar
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004185:Disability Evaluation; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
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