TNF Inhibitors or non-TNF Biologics - First Best Choice? Save

Prospective observational findings from the CORRONA registry of rheumatoid arthritis (RA) patients compared clinical outcomes between initial aggressive therapy using either a tumour necrosis factor inhibitor (TNFi) or a non-TNFi (biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs)) and found no difference between these diverse biologically targeted therapies. 

The Consortium of Rheumatology Researchers of North America Rheumatoid Arthritis (CORRONA) is a a large US healthcare registry that serially collects outcome and disease activity data. They compared 1-year outcomes of those starting a TNFi (adalimumab, etanercept, certolizumab pegol, golimumab or infliximab) or a non-TNFi (abatacept, tocilizumab, rituximab, anakinra or tofacitinib). Groups were propensity score-matched at baseline to account for potential confounding.

Overally, no significant differences were seen between the TNFi and non-TNFi treatment groups for outcomes assessed (CDAI, DAS28, HAQ, EuroQol-5, sleep, anxiety, morning stiffness and fatigue). But those on TNFi had less anemia (19.04 per 100 person-years) than the non-TNFi group (24.01 per 100 person-years, p=0.03). 

These findings are similar to that reported by van Vollenhoven and colleages in the NORD-STAR study that showed new RA patients equally achieved CDAI remission regardless of initial therapy with conventional DMARDs or methotrexate combined with a biologic (certolizumab, abatacept or tocilizumab).

These two studies showing therapeutic equivalence of initial aggressive therapies, further underscores the importance of early diagnosis, leading to earlier DMARD initiation as the way to achieve better outcomes.