関節リウマチに対する生物学的製剤の切り替え治療の成績

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  • Clinical Outcomes of Patients with Rheumatoid Arthritis after Switching Therapy of Biologic Agents
  • カンセツ リウマチ ニ タイスル セイブツガクテキ セイザイ ノ キリカエ チリョウ ノ セイセキ

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Objective: The objective of this study was to examine the efficacy of switching therapy of biologic agents in the treatment of rheumatoid arthritis (RA). <br>Methods: We examined 22 patients with RA (including 17 women, mean age 61.3 years, mean disease duration 11.9 years) followed up for more than 52 weeks after switching from their first biologic agent. The Disease Activity Score 28 (DAS 28)/erythrocyte sedimentation rate (ESR) and the continuation rate (CR, by Kaplan-Meier method) of the second biologic agent were investigated. In addition, we evaluated DAS 28-ESR and CR separately for anti-tumor necrosis factor alpha (TNF-α) antibody agents (infliximab and adalimumab), etanercept, and tocilizumab. <br>Results: DAS 28-ESR was significantly improved starting 4 weeks after switching to the second biologic agent and was maintained up to 52 weeks. The CR of the second biologic agent was 81.8% at 12 weeks, 68.2% at 24 weeks, and 62.5% at 104 weeks. When DAS 28-ESR was evaluated separately for each agent, switching to etanercept or tocilizumab showed significant improvement, but switching to an anti-TNF-α antibody did not. While the CR of etanercept was 84.6% at 52 weeks, the CR after switching from etanercept to other agents was 40.0% at 24 weeks. <br>Conclusion: Switching therapy of biologic agents is an available option, especially switching to etanercept; however, switching from etanercept to other biologic agents tended to make subsequent treatment difficult.

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