ACR70-disease activity score remission achievement from switches between all the available biological agents in rheumatoid arthritis: a systematic review of the literature

IntroductionThe aim of our analysis was to compare the gaining of a major response (disease activity score (DAS) remission or ACR 70) by switching between all the available biological therapies in rheumatoid arthritis.

Methods: A systematic review was performed including studies, published before December 2008, in which a second biological agent was used and clinical outcomes were evaluated after a first biological failure.

Results: 9 articles were included: switch from etanercept and/or infliximab and/or to adalimumab is effective with an ACR70 response from 5% to 33%. Rituximab may be slightly more effective than switching to a second anti-tumor necrosis factor alpha (TNF-alpha) reaching an ACR70 or DAS remission response in 12% and 9% respectively.

Clinical trials confirmed the efficacy in switching to abatacept (gain of effect 10.2%). Tocilizumab allows to reach DAS28 remission in 30.1% but ACR70 only in 12.4% of patients refractory to anti-TNFalpha.

Conclusions: The efficacy of a second biologic agent, irrespective of the mode of action, in reaching an ACR70 or DAS-remission after a first biologic is observed from 5 to 15% and from 9% to 15.4% respectively (except in two studies).

Author: Stefano AliverniniAntonella LariaElisa GremeseAngelo ZoliGianfranco Ferraccioli
Credits/Source: Arthritis Research &Therapy 2009, 11:R163

Published on: 2009-11-03

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