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Table 3 Information used to evaluate the proportion of patients achieving a response to a second biologic DMARD according to common criteria used in RA studies by reason for discontinuation of a first TNF-α inhibitora

From: Evaluating the efficacy of sequential biologic therapies for rheumatoid arthritis patients with an inadequate response to tumor necrosis factor-α inhibitors

Measure Reason for discontinuation Total number of patients Estimated response rate, % Biologics used to derive rate Treatment duration range, months Mean RA duration range, yr Reference sources
ACR20 Intolerance 337 62.5 ADA and TNF2 3 12 [17, 36, 51, 53]
  Lack of efficacy 251 48.4 ADA and ETN 3 to 4 9 to 12 [34, 36, 37, 53]
  Loss of efficacy 609 58.0 ADA and ETN 3 to 6 9 to 12 [30, 34, 36, 37, 53]
ACR50 Intolerance 337 35.7 ADA and ETN 3 12 [17, 36, 51, 53]
  Lack of efficacy 251 23.6 ADA and ETN 3 to 4 9 to 12 [34, 36, 37, 53]
  Loss of efficacy 537 29.6 ADA and ETN 3 to 4 9 to 12 [34, 36, 37, 53]
ACR70 Intolerance 337 13.4 ADA and TNF2 3 12 [17, 36, 51, 53]
  Lack of efficacy 251 9.0 ADA and ETN 3 to 4 9 to 12 [34, 36, 37, 53]
  Loss of efficacy 537 12.0 ADA and ETN 3 to 4 9 to 12 [34, 36, 37, 53]
DAS28 <2.6 Intolerance 443 15.2 ABA and TNF2 3 to 6 NR [17, 29]
DAS28 <3.2 Intolerance 211 30.4 TNF2 3 to 6 6 [17, 35]
  Lack of efficacy 98 13.0 TNF2 3 to 6 6 [35]
  Loss of efficacy 150 12.0 TNF2 3 to 6 6 [35]
EULAR moderate Intolerance 250 38.8 TNF2 3 to 6 9 [38, 45, 50]
  Lack of efficacy 98 37.0 TNF2 3 to 6 6 [35]
  Loss of efficacy 150 18.0 TNF2 3 to 6 6 [35]
EULAR good Intolerance 718 21.3 ADA and TNF2 3 to 12 6 to 12 [17, 35, 36, 38, 45, 50, 53]
  Lack of efficacy 320 15.2 ADA, ETN and TNF2 3 to 6 6 to 12 [3537]
  Loss of efficacy 515 16.9 ADA, ETN and TNF2 3 to 6 6 to 12 [3537]
EULAR moderate/good Intolerance 467 69.5 ADA and TNF2 3 to 6 6 to 12 [17, 35, 36, 45, 53]
  Lack of efficacy 349 63.2 ADA, ETN and TNF2 3 to 6 6 to 12 [3437, 53]
  Loss of efficacy 687 60.7 ADA, ETN and TNF2 3 to 6 6 to 12 [3437, 53]
  1. aDMARD, disease-modifying antirheumatic drug; RA, rheumatoid arthritis; ACR, American College of Rheumatology; DAS28, Disease Activity Score 28 joint count; EULAR, European League Against Rheumatism; ABA, abatacept, ADA, adalimumab, ETN, etanercept, TNFi, ith TNF-α inhibitor; ABA, abatacept; ADA, adamlimumab; TNFi, ith TNF-α inhibitor. ACR20 means a 20% improvement in tender or swollen joint counts as well as 20% improvement in at least three of the following five criteria: patient assessment, physician assessment, erythrocyte sedimentation rate, pain scale and functional questionnaire. The ACR50 and ACR70 categories adhere to the same criteria, but for 50% and 70% improvement, respectively.