Comparing treatment options for rheumatoid arthritis unresponsive to anti-TNF drugs

This study compared the effectiveness of different biological drugs in patients with rheumatoid arthritis who have already been unresponsive to anti-tumor necrosis factor (TNF) treatment. The authors concluded that a non-TNF biological treatment was more effective at lowering disease activity than taking a second anti-TNF drug. 

There are many forms of treatment for rheumatoid arthritis (RA). Biological drugs are becoming a more commonly prescribed treatment option. There are many types of biological drugs with anti-tumor necrosis factor (TNF) drugs, such as adalimumab (Humira) or infliximab (Remicade), the most widely used. They work by blocking the activity of a protein called tumor necrosis factor. This protein is known to contribute to inflammation seen in RA.

If a patient does not respond to primary anti-TNF treatment, a second anti-TNF drug may be prescribed. Alternatively, a patient may be prescribed a completely different biological drug such as rituximab (Rituxan), tocilizumab (Actemra), or abatacept (Orencia). What kind of secondary treatment is most beneficial for patients unresponsive to primary anti-TNF therapy is still under investigation.

269 RA patients with persistent disease activity were included in this study. All patients had previously received treatment with an anti-TNF drug and were not responding to treatment.

Patients were randomly assigned to receive either a second anti-TNF drug or a non TNF-targeted drug. The non TNF-targeted drugs were abatacept, tocilizumab, or rituximab. The study was carried out over 52 weeks. The authors looked at responsiveness of patients to their treatment after 24 weeks.

69% of patients receiving non-TNF drugs showed good or moderate response to their treatment. In contrast, 52% of those receiving a second anti-TNF drug showed the same response. 45% of patients in the non-TNF group showed low disease activity at 24 weeks. This was significantly greater compared to 28% with anti-TNF treatment. 

The authors concluded that a non-TNF drug was more effective at lowering disease activity than a second anti-TNF drug in patients unresponsive to primary anti-TNF therapy.

Some of the authors are affiliated with the manufacturers drugs used in this study.