Is Switching TNF Inhibitors Beneficial to Patients with Axial Spondyloarthritis?

Switching from one tumor necrosis factor (TNF) inhibitor to another may be a feasible treatment option in patients with axial spondyloarthritis (axSpA) who lose their response to the first TNF inhibitor, according to a recent study.

Previously, when patients with axSpA had an inadequate response to initial TNF inhibitor therapy, there was little choice but to switch to another TNF inhibitor. However, now that there are other options for the treatment of TNF inhibitor-inadequate responder patients, it has become more of a priority to test the efficacy of switching to a second TNF inhibitor against these options, the researchers noted.
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They conducted a literature review of articles reporting outcomes related to switching biologic therapies in patients with axSpA. Overall, 21 studies were included in the analysis. The most commonly reported reasons for switching to a second TNF inhibitor were lack of efficacy (14% to 68%), loss of efficacy (13% to 61%), and adverse events (13% to 57%).

Overall, “[s]witching TNF inhibitors was beneficial for a substantial proportion of patients with axSpA who failed to respond to initial or even second TNF inhibitor therapy and adverse effect were not enhanced.”

Drug survival rates were lower for the second and third TNF inhibitor, generally, and male sex and peripheral arthritis being predictors of drug survival. Patients who switched TNF inhibitors were commonly female, older, had more severe disease, had greater symptom burden, had higher erythrocyte sedimentation rate, had complete ankyloses, or had enthesitis. 

“In conclusion, findings from this critical analysis of the literature indicate that switching TNF inhibitors is beneficial for a substantial proportion of patients with axSpA who fail to respond to initial TNF inhibitor therapy.”

“With the approval of secukinumab, a new non-TNF biologic is available to treat patients with [ankylosing spondylitis]. A future study that compares the efficacy of 2 strategies––patients switching from one TNF inhibitor to another TNF inhibitor, or patients switching from TNF inhibitor to secukinumab––would be very informative.”

—Michael Potts

Reference:

Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis [published online April 25, 2017]. Semin Arthritis Rheum. doi: dx.doi.org/10.1016/j.semarthrit.2017.04.005.