title: Drug retention rates of second biologic agents after switching from tumor necrosis factor inhibitors for rheumatoid arthritis in Japanese patients on low-dose methotrexate or without methotrexate.
abstract: OBJECTIVE
  The purpose of this study was to explore drug retention rates of second biologic agents after switching from tumor necrosis factor inhibitors (TNFi) in clinical practice in patients with rheumatoid arthritis (RA) on low-dose methotrexate (MTX) or without MTX.
  
  
  METHODS
  A total of 169 RA patients who had been withdrawn from first-course TNFi therapy and received a different TNFi or tocilizumab (TCZ) as a second biologic agent were selected from the Tsurumai Biologics Communication Registry, an observational cohort database. Retention rates of second biologic treatment were compared by the type of first TNFi and second biologic agents.
  
  
  RESULTS
  Eighty-six patients received first-course infliximab (IFX) or adalimumab (ADA) therapy, and 83 patients received first-course etanercept (ETN) therapy. The former group had a significantly higher retention rate (IFX, 81.1%; ADA, 83.3%) of the second biologic therapy compared to the latter (56.6%, p < 0.001, log-rank test). Drug retention rates of the second biologic agent after switching from IFX/ADA were significantly higher with ETN (90.0%) and TCZ (94.7%) than with ADA/IFX (59.3%). Drug retention rates of the second biologic agent after switching from ETN were significantly higher with TCZ (75.9%) than with ADA/IFX (46.3%). The differences were significant even after adjusting for baseline clinical variables using the Cox proportional hazards model.
  
  
  CONCLUSIONS
  Drug retention rates of IFX and ADA after switching from the first TNFi were significantly lower compared to those of ETN and TCZ in patients on low-dose MTX or without MTX.
authors.affiliation: Department of Orthopedic Surgery and Rheumatology,Nagoya University Hospital , Nagoya Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kobayakawa
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.forename: Nobunori
authors.initials: N
authors.lastname: Takahashi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hayashi
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kaneko
authors.forename: Tomone
authors.initials: T
authors.lastname: Shioura
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Saito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirano
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Kanayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Miyake
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Asai
authors.forename: Koji
authors.initials: K
authors.lastname: Funahashi
authors.forename: Shinya
authors.initials: S
authors.lastname: Hirabara
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hanabayashi
authors.forename: Shuji
authors.initials: S
authors.lastname: Asai
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: Methotrexate; Rheumatoid arthritis; Second-line drug; TNF inhibitor; Tocilizumab