title: Switching from an anti-TNF monoclonal antibody to soluble TNF-receptor yields better results than vice versa: An observational retrospective study of 72 rheumatoid arthritis switchers.
abstract: OBJECTIVE
  To evaluate the benefits for rheumatoid arthritis (RA) patients of switching from one tumor necrosis factor inhibitor (TNFi) to another based on reason for change (primary failure, escape or intolerance) and molecule-switching order.
  
  
  METHODS
  Between 2000 and 2008, 356 RA patients prescribed a TNFi (infliximab [IFX], etanercept [ETA] or adalimumab [ADA]) and undergoing standardized evaluation were included in this retrospective study. Detailed demographic, clinical and biological data were collected before first biologic use and ≤6 months later to evaluate response based on EULAR-criteria. Primary failure, escape or intolerance of first TNFi triggered switch to another TNFi, the response of which was evaluated 6 months later. Propensity score then measured any interaction with baseline variables.
  
  
  RESULTS
  Of the 356 RA patients, 38 switched from IFX/ADA to ETA, 26 from ETA to IFX/ADA, and eight from one monoclonal antibody (mAb; IFX/ADA) to another. Clinical parameters for switchers and non-switchers were comparable. Switchers changed therapies because of primary failure (36.1%), escape (33.3%), or intolerance (30.6%), with no difference found in these subgroups. More switchers responded to the second TNFi than the first (P<0.01), respectively, regardless of switch (ETA to IFX/ADA: 50 vs. 23.1% [P<0.05]; IFX/ADA to ETA: 57.9 vs. 15.8% [P<0.001]) or reason for changing. In addition, DAS28 decreased more with the second antagonist (P<0.001) and regardless of molecules switched (P<0.01). Survival of the second TNFi was significantly longer with switch from mAb to the soluble receptor than vice versa (P<0.05).
  
  
  CONCLUSIONS
  Overall, any switching from one TNFi to another, especially mAb to soluble receptor, was often beneficial for RA patients.
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France. Electronic address: thierry.lequerre@chu-rouen.fr.
authors: Thierry
authors: T
authors: Lequerré
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Émilie
authors: É
authors: Farran
authors: Biostatistics department, Rouen university hospital, institute for research and innovation in biomedicine, university of Rouen, 76031 Rouen cedex, France.
authors: Jean-François
authors: JF
authors: Ménard
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Macha
authors: M
authors: Kozyreff-Meurice
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Thibault
authors: T
authors: Vandhuick
authors: Pharmacy department, Rouen university hospital, institute for research and innovation in biomedicine, university of Rouen, 76031 Rouen cedex, France.
authors: Christine
authors: C
authors: Tharasse
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Sophie
authors: S
authors: Pouplin
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Alain
authors: A
authors: Daragon
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Xavier
authors: X
authors: Le Loët
authors: Pharmacy department, Rouen university hospital, institute for research and innovation in biomedicine, university of Rouen, 76031 Rouen cedex, France.
authors: Rémi
authors: R
authors: Varin
authors: Rheumatology department, Rouen university hospital, Inserm unit 905, institute for research and innovation in biomedicine, university of Rouen, CIC/CRB 1404, 76031 Rouen cedex, France.
authors: Olivier
authors: O
authors: Vittecoq
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D057915:Drug Substitution; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Adalimumab; Etanercept; Infliximab; Rheumatoid arthritis; Switching; TNF-blocking agent