title: Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study.
abstract: BACKGROUND
  Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients do not respond or do not tolerate their first TNFi, and are switched to a different TNFi. Evidence supporting this practice is limited, and we wanted to investigate the effectiveness of switching to a second TNFi.
  
  
  METHODS
  From a longitudinal observational study (LOS) we selected patients with PsA who were starting their first TNFi, and identified patients who had switched to a second TNFi ('switchers'). Three-month responses and 3-year drug-survival were compared between switchers and non-switchers, and within switchers.
  
  
  RESULTS
  Switchers (n=95) receiving their second TNFi had significantly poorer responses compared with non-switchers (n=344) (ACR50 response: 22.5% vs 40.0%, DAS28 remission: 28.2% vs 54.1%). There was a trend towards poorer responses to the second TNFi compared with the first TNFi within switchers. Estimated 3-year drug-survival was 36% for the second TNFi compared with 57% for the first TNFi overall.
  
  
  CONCLUSIONS
  20-40% of patients had a response on a second TNFi after having failed one TNFi in this LOS. This observation highlights the need for treatments with other mechanisms of action than TNF inhibition in patients with PsA.
authors.affiliation: Deprtment of Rheumatology, Diakonhjemmet Hospital, , Oslo, Norway.
authors.forename: Karen Minde
authors.initials: KM
authors.lastname: Fagerli
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Marte Schrumpf
authors.initials: MS
authors.lastname: Heiberg
authors.forename: Synøve
authors.initials: S
authors.lastname: Kalstad
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.forename: Knut
authors.initials: K
authors.lastname: Mikkelsen
authors.forename: Ase Stavland
authors.initials: AS
authors.lastname: Lexberg
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D000068582:Certolizumab Pegol; D057915:Drug Substitution; D000068800:Etanercept; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007140:Immunoglobulin Fab Fragments; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D000068582:Certolizumab Pegol
keywords: Anti-TNF; Psoriatic Arthritis; Treatment