Survey of patients with rheumatoid arthritis switching biologic treatments
C. Masih, N. Maiden, Elaine Wylie
Department of Rheumatology, Craigavon Area Hospital, Southern Health and Social Care Trust
We are aware that patients on biologic therapy often have to switch treatments, sometimes more than once and wanted to study our population of patients with rheumatoid arthritis switching biologic treatments.
Aims were to assess the reasons for switching therapy (failure or side effects), the length of time that treatments persist and the effectiveness of various biologic treatments when used as a second or third line treatment and beyond.
A retrospective electronic record review was carried out of all patients with rheumatoid arthritis on biologic therapies who had switched treatments since the biologics service was introduced in Craigavon Area Hospital.
Seventy-nine patients switched biologic treatments. Twenty-four required a third biologic and seven a fourth. One patient required six biologics. The main reasons for switching therapy were primary or secondary failure. The rate of adverse effects was approximately 20% for all biologics except infliximab (for which numbers were small) and rituximab which had a rate of 6%. Side effects included infections, injection site reactions, neutropenia and other recognised adverse effects. Two deaths were unrelated to biologic treatment. Rituximab was the most efficacious biologic when used second or third line with success rates of 81% and 80%. Where abatacept or an anti-TNF biologic was used second line success rates were 50% or less. Tocilizumab was efficacious though numbers were fewer.
Rituximab was the most efficacious and had a low rate of side effects when used second or third line. There was a low rate of withdrawal from biologic treatment within the cohort of patients switching biologics.