title: Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication.
abstract: OBJECTIVE
  After treatment failure with a tumor necrosis factor inhibitor (TNFi), patients with rheumatoid arthritis (RA) can switch to another TNFi (TNFi cyclers) or to a targeted disease-modifying antirheumatic drug (DMARD) with a non-TNFi mechanism of action (non-TNFi switchers). This study compared treatment patterns and treatment effectiveness between TNFi cyclers and non-TNFi switchers in patients with RA.
  
  
  METHODS
  The analysis included a cohort of patients from the Truven Health Analytics MarketScan Commercial database with RA who switched from a TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) either to another TNFi or to a non-TNFi targeted DMARD (abatacept, tocilizumab, or tofacitinib) between January 1, 2010 and September 30, 2014. A claims-based algorithm was used to estimate treatment effectiveness based on six criteria (adherence, no dose increase, no new conventional therapy, no switch to another targeted DMARD, no new/increased oral glucocorticoid, and intra-articular injections on <2 days).
  
  
  RESULTS
  The cohort included 5,020 TNFi cyclers and 1,925 non-TNFi switchers. Non-TNFi switchers were significantly less likely than TNFi cyclers to switch therapy again within 6 months (13.2% vs 19.5%;P<0.001) or within 12 months (29.7% vs 34.6%;P<0.001) and significantly more likely to be persistent on therapy at 12 months (61.8% vs 58.2%;P<0.001). Non-TNFi switchers were significantly more likely than TNFi cyclers to achieve all six of the claims-based effectiveness algorithm criteria for the 12 months after the initial switch (27% vs 24%;P=0.011).
  
  
  CONCLUSIONS
  Although the absolute differences were small, these results support switching to a non-TNFi targeted DMARD instead of TNFi cycling when patients with RA require another therapy after TNFi failure.
authors.affiliation: Outcomes Research, Truven Health Analytics, Cambridge, MA.
authors.forename: Machaon Mk
authors.initials: MM
authors.lastname: Bonafede
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: Outcomes Research, Truven Health Analytics, Cambridge, MA.
authors.forename: Donna
authors.initials: D
authors.lastname: McMorrow
authors.affiliation: Health Economics and Outcomes Research, Sanofi, Bridgewater, NJ.
authors.forename: Puneet
authors.initials: P
authors.lastname: Mahajan
authors.affiliation: Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
authors.forename: Chieh-I
authors.initials: CI
authors.lastname: Chen
keywords: biologic; rheumatoid arthritis; switching; tumor necrosis factor inhibitor