Evaluating the Efficacy of Sequential Biologic Therapies for Rheumatoid Arthritis Patients with an Inadequate Response to Tumor Necrosis Factor-Alpha Inhibitors

Methods

A systematic search was undertaken to identify published peer-reviewed articles that reported clinical outcomes of biologic treatment among RA patients with an inadequate response to TNF-alpha inhibitors. Data were systematically abstracted. Efficacy rates were estimated for groups of patients who differed in the number of prior TNF-alpha inhibitors used. Endpoints included ACR- (American College of Rheumatology), EULAR- (European League Against Rheumatism) and DAS (Disease Activity Score) 28-based response criteria.

Results

The search identified 41 publications, of which 28 reported biologic treatment outcomes for RA patients with prior exposure to TNF-alpha inhibitors. Seven publications reported outcomes obtained in randomized clinical trials, while the remaining consisted of observational studies. The likelihood of responding to a subsequent biologic treatment decreased as the number of previous treatments with TNF-alpha inhibitors increased for 6 out of the 8 response criteria examined.

Conclusions

For patients with prior exposure to TNF-alpha inhibitors, likelihood of response to subsequent treatment with biologic agents declines with increasing number of previous treatments with TNF-alpha inhibitors.

The full, provisional article is published online within the journal, Arthritis Research and Therapy and is free to access.