title: Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis.
abstract: BACKGROUND
  The aim of this study was to compare the response between subsequent use of anti-tumor necrosis factor α (anti-TNF) agents and biologic disease-modifying anti-rheumatic drugs (bDMARD) with other mechanism of action (MOA) in rheumatoid arthritis (RA) patients with history of anti-TNF treatment as their first bDMARD.
  
  
  METHODS
  A retrospective chart review was conducted at eight community-based rheumatology practices in the United States in 2012. Routine Assessment of Patient Index Data 3 (RAPID3) response was measured by comparing baseline and 6-month scores. Poor response was defined as decrease <1.8 points, follow-up score >12, or treatment discontinuation before 6 months. Percentages of patients with good and good or moderate RAPID3 response were compared for second and third biologics. Multivariate models controlled for potential confounders.
  
  
  RESULTS
  Of 176 patients whose charts were abstracted, 122 (69.3%) received another anti-TNF agent after they discontinued their first anti-TNF. RAPID3 scores were available for 160 patients. A patient receiving a second bDMARD with another MOA had a higher good or moderate response than a patient receiving anti-TNF (53.5 vs. 30.7%, p = 0.01). In the multivariate models, treatment with another MOA was more likely to produce a good RAPID3 response [odds ratio (OR), 2.42; 95% confidence interval (CI), 1.05-5.58] or a good or moderate response (OR, 2.21; 95% CI, 1.23-3.97) than treatment with an anti-TNF.
  
  
  CONCLUSIONS
  In patients who have discontinued anti-TNF agents as their first bDMARD, RAPID3 response rates are better for those receiving agents with a different MOA rather than another anti-TNF. Physicians should consider using a bDMARD with a different MOA as the next bDMARD for RA patients whose anti-TNF agent has failed.
authors.affiliation: Taylor Hospital, 175 East Chester Pike, Ridley Park, PA, 19078, USA.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Bergman
authors.affiliation: ICON Clinical Research, 456 Montgomery Street, Suite 2200, San Francisco, CA, 94104, USA. elkineric@gmail.com.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Elkin
authors.affiliation: Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
authors.forename: Sarika
authors.initials: S
authors.lastname: Ogale
authors.affiliation: Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
authors.forename: Tripthi
authors.initials: T
authors.lastname: Kamath
authors.affiliation: Rheumatology Associates of Long Island, 1895 Walt Whitman Road, Melville, NY, 11747, USA.
authors.forename: Max I
authors.initials: MI
authors.lastname: Hamburger
keywords: Anti-rheumatic agents; Arthritis, rheumatoid; Biological therapy; Treatment failure; Tumor necrosis factor alpha