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Open Access 01-12-2009 | Research article

DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists

Authors: Federico Navarro-Sarabia, Dolores Ruiz-Montesinos, Blanca Hernandez, Victoria Navarro-Compán, Sara Marsal, Mireia Barcelo, Eva Perez-Pampín, Juan J Gómez-Reino

Published in: BMC Musculoskeletal Disorders | Issue 1/2009

Abstract

Introduction

No definitive data are available regarding the value of switching to an alternative TNF antagonist in rheumatoid arthritis patients who fail to respond to the first one. The aim of this study was to evaluate treatment response in a clinical setting based on HAQ improvement and EULAR response criteria in RA patients who were switched to a second or a third TNF antagonist due to failure with the first one.

Methods

This was an observational, prospective study of a cohort of 417 RA patients treated with TNF antagonists in three university hospitals in Spain between January 1999 and December 2005. A database was created at the participating centres, with well-defined operational instructions. The main outcome variables were analyzed using parametric or non-parametric tests depending on the level of measurement and distribution of each variable.

Results

Mean (± SD) DAS-28 on starting the first, second and third TNF antagonist was 5.9 (± 2.0), 5.1 (± 1.5) and 6.1 (± 1.1). At the end of follow-up, it decreased to 3.3 (± 1.6; Δ = -2.6; p > 0.0001), 4.2 (± 1.5; Δ = -1.1; p = 0.0001) and 5.4 (± 1.7; Δ = -0.7; p = 0.06). For the first TNF antagonist, DAS-28-based EULAR response level was good in 42% and moderate in 33% of patients. The second TNF antagonist yielded a good response in 20% and no response in 53% of patients, while the third one yielded a good response in 28% and no response in 72%. Mean baseline HAQ on starting the first, second and third TNF antagonist was 1.61, 1.52 and 1.87, respectively. At the end of follow-up, it decreased to 1.12 (Δ = -0.49; p < 0.0001), 1.31 (Δ = -0.21, p = 0.004) and 1.75 (Δ = -0.12; p = 0.1), respectively. Sixty four percent of patients had a clinically important improvement in HAQ (defined as ≥ -0.22) with the first TNF antagonist and 46% with the second.

Conclusion

A clinically significant effect size was seen in less than half of RA patients cycling to a second TNF antagonist.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/10/91/prepub

Title: DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists
Authors: Federico Navarro-Sarabia
Dolores Ruiz-Montesinos
Blanca Hernandez
Victoria Navarro-Compán
Sara Marsal
Mireia Barcelo
Eva Perez-Pampín
Juan J Gómez-Reino
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2009
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-10-91

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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