401. ACR70-disease activity score remission achievement from switches between all the available biological agents in rheumatoid arthritis: a systematic review of the literature
- Author
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Gianfranco Ferraccioli, Elisa Gremese, Antonella Laria, Stefano Alivernini, and Angelo Zoli
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musculoskeletal diseases ,medicine.medical_specialty ,Immunoconjugates ,Immunology ,ACR70-disease activity score remission achievement ,Antibodies, Monoclonal, Humanized ,Receptors, Tumor Necrosis Factor ,Rheumatoid arthrtitis ,biologics ,Etanercept ,Abatacept ,Arthritis, Rheumatoid ,Antibodies, Monoclonal, Murine-Derived ,chemistry.chemical_compound ,Tocilizumab ,Rheumatology ,Internal medicine ,Adalimumab ,medicine ,Humans ,Immunology and Allergy ,skin and connective tissue diseases ,Clinical Trials as Topic ,business.industry ,Remission Induction ,Antibodies, Monoclonal ,medicine.disease ,Infliximab ,Antirheumatic Agents ,chemistry ,Immunoglobulin G ,Rheumatoid arthritis ,Orthopedic surgery ,Physical therapy ,Rituximab ,business ,Research Article ,medicine.drug - Abstract
Introduction The aim of our analysis was to compare the gaining of a major response (disease activity score [DAS] remission or American College of Rheumatology 70% improvement criteria [ACR70]) by switching between all the available biological therapies in rheumatoid arthritis. Methods A systematic review was performed including studies, published before December 2008, in which a second biological agent was used and clinical outcomes were evaluated after a first biological failure. Results Nine articles were included. Switching from etanercept and/or infliximab to adalimumab is effective with an ACR70 response ranging from 5% to 33%. Rituximab may be slightly more effective than switching to a second anti-tumor necrosis factor-alpha (anti-TNFα), reaching an ACR70 or DAS remission response in 12% and 9%, respectively. Clinical trials confirmed the efficacy in switching to abatacept (gain of effect 10.2%). Tocilizumab allows DAS28 (DAS using 28 joint counts) remission in 30.1% but ACR70 only in 12.4% of patients refractory to anti-TNFα. Conclusions The efficacy of a second biological agent, irrespective of the mode of action, in reaching an ACR70 or DAS remission after a first biologic is observed from 5% to 15% and from 9% to 15.4%, respectively (except in two studies).
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