title: Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden.
abstract: OBJECTIVE
  Because new modes of action for the treatment of psoriatic arthritis (PsA) are emerging, it is important to understand the use of switching to a second or third antitumor necrosis factor (anti-TNF) agent. This study investigated drug survival and treatment response rates of patients with PsA undergoing second- and third-line anti-TNF therapy.
  
  
  METHODS
  Patients with PsA were monitored in a prospective, observational study. Patients who switched anti-TNF therapy once (first-time switchers, n = 217) or twice (second-time switchers, n = 57) between January 2003 and March 2012 were studied. American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) good response at 3 and 6 months, as well as drug survival, were reported and further analyzed using the Cox and logistic regression models.
  
  
  RESULTS
  Median age for first-time switchers was 47 years and 42% were men. The corresponding values for second-time switchers were 48 years and 40% men. Three-month ACR20 Lund Efficacy Index (LUNDEX) response was achieved by 47% of first-time and 22% of second-time switchers; ACR50 LUNDEX rates were 21% and 14%, ACR70 LUNDEX rates were 12% and 2%, and EULAR good LUNDEX rates were 26% and 10%, respectively. Median drug survival time for patients switching anti-TNF for the first time was 64 months (95% CI 31-97) compared with 14 months (95% CI 5-23) for second-time switchers. Identified baseline predictor of ACR20 response to second-line treatment was the 28-joint Disease Activity Score values at baseline (OR 1.45, 95% CI 1.01-2.10), while higher Health Assessment Questionnaire scores predicted premature drug withdrawal (HR 1.60, 95% CI 1.03-2.48).
  
  
  CONCLUSIONS
  Response rates of first-time anti-TNF switchers are moderate, while the inferior response rates of second-time switchers suggest other therapeutic options should be considered in this situation.
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital. Larserik_kristensen@yahoo.com.
authors.forename: Lars Erik
authors.initials: LE
authors.lastname: Kristensen
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital.
authors.forename: Lennart T H
authors.initials: LT
authors.lastname: Jacobsson
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital.
authors.forename: Robin
authors.initials: R
authors.lastname: Christensen
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Mease
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital.
authors.forename: Henning
authors.initials: H
authors.lastname: Bliddal
authors.affiliation: From the Department of Rheumatology, and Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Sahlgrenska University, Gothenburg; Department of Rheumatology, Lund University Hospital, Lund, Sweden; Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark.L.E. Kristensen, MD, PhD, Department of Rheumatology, the Parker Institute, and Department of Rheumatology, Lund University Hospital; E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L.T. Jacobsson, MD, PhD, Department of Rheumatology, Sahlgrenska University; R. Christensen, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P.J. Mease, MD, PhD, Department of Rheumatology, Swedish Medical Center; H. Bliddal, MD, PhD, Copenhagen University Hospital at Frederiksberg, and Musculoskeletal Statistics Unit, the Parker Institute; P. Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital.
authors.forename: Pierre
authors.initials: P
authors.lastname: Geborek
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D057915:Drug Substitution / Q000379:methods*; D000068800:Etanercept / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013548:Sweden; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: ANTI-TUMOR NECROSIS FACTOR; OBSERVATIONAL STUDY; PREDICTORS; PSORIATIC ARTHRITIS; SWITCHING