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

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 inhibitor^a

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	[35–37]
	Loss of efficacy	515	16.9	ADA, ETN and TNF₂	3 to 6	6 to 12	[35–37]
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	[34–37, 53]
	Loss of efficacy	687	60.7	ADA, ETN and TNF₂	3 to 6	6 to 12	[34–37, 53]

^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, TNF_i, ith TNF-α inhibitor; ABA, abatacept; ADA, adamlimumab; TNF_i, i^th 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.

ISSN: 1478-6362