TNFi cycling in axSpA: Results from CorEVITAS Registy study Save

Many practicing, and retired, rheumatologists will recall a time when we only had TNFi for the treatment of SpA.

These drugs changed the landscape of disease and for the first time, we felt we had control. Naturally, it became practice that if a patient failed one TNFi you would cycle to another.

Now, the playing field has multiple MOAs available, and yet, we continue to see cycling. Much of this can be attributed to attitudes and historical practice, with consideration for an additional element: insurance formulary. 

CorEVITAS registry abstract 1499 was designed to understand TNFi cycling in axSpA. The analyses were conducted on nearly 90 patients who had previously been treated with a TNFi and subsequently placed on another. BASDAI and ASDAS scores were evaluated at 6 month intervals through 24 months after starting the second TNFi. On average, patients spent nearly 16 months on the initial TNFi prior to changing, citing lack of efficacy as primary reason for discontinuation. Nearly a quarter of the patients were also on concomitant NSAID therapy. Six months after starting the second TNFi none of the patients achieved major improvement on ASDAS and less than 10% reported BASDAI ≥50% improvement. This data shows that cycling through TNFi in axSpA patients with primary lack of efficacy with first line TNFi has limited additional benefit in controlling disease. 

I will consider utilizing this, and previously documented data, for future prior authorization rebuttals.