title: Real-world effectiveness of anti-TNF switching in psoriatic arthritis: a systematic review of the literature.
abstract: Anti-tumor necrosis factors (Anti-TNFs) are a class of biologic disease-modifying anti-rheumatic drugs indicated for the treatment of moderate-to-severe psoriatic arthritis (PsA). Refractory patients are commonly managed by switching from one anti-TNF to another. To assess the evidence on the effectiveness of anti-TNF cycling in PsA patients, a systematic review of the literature was conducted. MEDLINE- and Embase-indexed English-language publications were systematically searched from 1995 to 2015 for studies assessing real-world effectiveness outcomes of anti-TNF cycling in PsA patients. Of 1086 citations identified, 18 studies were included; most conducted in Europe. Six of seven studies testing between lines found significant differences in effectiveness between earlier and subsequent lines of anti-TNF therapy. First-line therapy yielded better results compared with second-line therapy, and significant differences were observed between second- and third-line anti-TNF treatments. In the only study with multivariate regression testing for predictors of response, Danish registry patients were less likely to respond (American College of Rheumatology 20 % or 50 % response) to a second anti-TNF course if safety, rather than lack of effect, caused them to switch (odds ratio [OR] 0.04; p = 0.003 and OR 0.05; p = 0.03, respectively). Effectiveness of anti-TNFs at second line and later is reported in a small number of real-world studies of PsA patients. Subsequent treatment lines may be associated with less response in some measures. More research is needed to quantify the effectiveness of sequential anti-TNF lines in this progressive population' and to compare these effects with responses to drugs with different mechanisms of action.
authors.affiliation: New York University School of Medicine, 462 1st Avenue, New York, NY, 10016, USA. Soumya.Reddy@nyumc.org.
authors.forename: Soumya M
authors.initials: SM
authors.lastname: Reddy
authors.affiliation: Evidera, Waltham, MA, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Crean
authors.affiliation: Evidera, Waltham, MA, USA.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Martin
authors.affiliation: Evidera, Waltham, MA, USA.
authors.forename: Meghan D
authors.initials: MD
authors.lastname: Burns
authors.affiliation: Novartis Pharmaceuticals Corporation, Health Economics and Outcomes Research, East Hanover, NJ, USA.
authors.forename: Jacqueline B
authors.initials: JB
authors.lastname: Palmer
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000276:immunology*; D001688:Biological Products / Q000627:therapeutic use; D003718:Denmark; D057915:Drug Substitution / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012042:Registries; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF cycling; Psoriatic arthritis; Systematic literature review