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TNFi Cycling vs. Swapping Biologics in Rheumatoid Arthritis

Jun 25, 2020 6:55 pm

For years, rheumatologists would rather fight to stay on a TNF inhibitor (TNFi) than switch to a non-TNFi biologic when rheumatoid arthritis (RA) therapy fails. A new prescriber analysis shows that after the first TNFi failure, a second TNFi is still preferred over swapping to a non‐TNFi, even though there was greater time on drug with a non‐TNFi biologic. 

Despite decades of TNFi reliance and dominance, the last decade has revealed several studies that have challenged the sequence of biologic use in RA. The current study was undertaken to study to the cost and outcomes of TNFi cycling versus TNFi switching (to a non-TNFi biologic) using claims data of insured adult RA patients who switched to their second biological or targeted disease‐modifying antirheumatic drug between January 2008 and December 2015. 

The analysis included 0,442 RA patients who changed their initial TNFi - one third (36.5%) switched to a non‐TNFi drug (mostly abatacept 54.2% ) and two-thirds (63.5%) cycled to a second TNF (mostly adalimumab 41.2%).

Non‐TNFi biologic were more likely to be used in older patients and had those with more comorbidities (p < 0.001).

Success was determinted by time on drug - survival analyses and favored non‐TNFi biologics (median 605 days) over TNFi (489 days;, p < 0.001).

Interestingly, TNFi cycling was associated with lower costs, even though.non‐TNFi were less less expensive in adherent patients.

The author has received compensation as an advisor or consultant on this subject

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