Non-tumor necrosis factor (TNF) drugs are more effective than anti-TNF drugs in some patients with rheumatoid arthritis, according to the results of a clinical trial, published in the Journal of the American Medical Association.
Anti-TNF drugs are used worldwide to treat rheumatoid arthritis. They work by inactivating TNF, a molecule produced by the immune system that causes inflammation. However, around a third of rheumatoid arthritis patients do not respond to this type of therapy.
In the study, “Non–TNF-Targeted Biologic vs a Second Anti-TNF Drug to Treat Rheumatoid Arthritis in Patients With Insufficient Response to a First Anti-TNF Drug, A Randomized Clinical Trial,” a large team of researchers carried out a clinical trial (NCT0100041) on 300 rheumatoid arthritis patients over a period of 52 weeks. All patients had insufficient response to anti-TNF drugs.
Participants were divided into two groups. Those in the first group received an anti-TNF drug that was different from their previous treatment. These included Humira (adalimumab), given to 39% of the patients; Enbrel (etanercept), given to 36%; Cimzia (certolizumab), given to 16%; and Remicade (infliximab), given to 5% of the patients.
Those in the second group received a non-TNF-targeted biologic agent, such as Actemra (tocilizumab), given to 48% of the patients; Rituxan (rituximab), given to 28%; and Orencia (abatacept), given to 23% of the patients.
Results showed that 54% of the patients in the anti-TNF group, and 69% of those in the non-TNF group showed at least a moderate response to treatment, as measured by the European League Against Rheumatism (EULAR) scale.
“The study demonstrates a superior effectiveness of a non-TNF targeted [drugs] over second anti-TNF,” said the study’s first author, Dr. Jacques-Eric Gottenberg, with the Department of Rheumatology at the University of Strasbourg, France, in a press release. “The results provide guidance for the therapeutic strategy choice in patients with rheumatoid arthritis and insufficient response to a first anti-TNF.”
Moreover, more patients in the non-TNF group showed low disease activity after both 24 and 52 weeks of treatment.
The researchers concluded that in patients with rheumatoid arthritis who were previously treated with anti-TNF drugs but did not respond well, a non-TNF biologic agent is more effective than a second anti-TNF drug to achieve a moderate disease activity.