Second anti-TNF or other biologic may help some RA patients who failed initial anti-TNF treatment

SAN FRANCISCO — According to research presented here, almost half of patients with rheumatoid arthritis who did not respond to treatment with a first anti-tumor necrosis factor biologic responded to a second treatment with a different biologic — regardless of anti-drug antibody status — although a biologic drug of a different mechanism of action may be more effective.

During a press conference at the American College of Rheumatology Annual Meeting, Jacques-Eric Gottenberg, MD, PhD, of the National Reference Center for Systemic Autoimmune Diseases in the Department of Rheumatology at the Strasbourg University Hospital in France, said he and his team studied a group of 278 patients with refractory rheumatoid arthritis (RA) who had attempted treatment with, but did not respond to, an anti-tumor necrosis factor (anti-TNF) agent.

The patients were randomized to receive either a second anti-TNF agent at the discretion of their physician that included Humira (adalimumab; AbbVie), Cimzia (certolizumab pegol; UCB), Enbrel (etanercept; Amgen) or Remicade (infliximab; Janssen); or a biologic treatment of a different mechanism, including Orencia (abatacept; Bristol-Myers Squibb), Rituxan (rituximab; Genentech, Biogen Idec) or Actemra (tocilizumab; Genentech).

Analysis showed 64.2% of patients had a good or moderate response to a second non-TNF-targeted biologic drug, while 47.8% of patients responded to a different anti-TNF agent after 3 months.

At 6 months, the number increased to 69.7% of patients who received a biologic other than an anti-TNF agent and 52.1% of patients who received an anti-TNF therapy. At 12 months, investigators found the proportions dropped to 60% and 43.2%, respectively.

An additional analysis at 20 months revealed 25 patients had developed anti-drug antibodies. Investigators found none of these patients received etanercept. The presence of anti-drug anti-bodies was not associated with treatment outcome, and patients with the antibodies responded comparably to other patients. - by Shirley Pulawski

Reference:

Gottenberg JE, et al. Papers #3113. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.

Disclosures: Gottenberg reports the receipt of funding from Abbvie, MSD, Pfizer, Roche and BMS. The other researchers report no relevant financial disclosures.