When is switching warranted among biologic therapies in rheumatoid arthritis?

Abstract

Switching among biologic therapies is common practice in patients with rheumatoid arthritis who have an inadequate response or intolerable adverse events. Evidence from observational studies and association guidelines supports the use of sequential biologic therapy for these reasons. Owing to recent economic pressures on healthcare budgets, patients with rheumatoid arthritis who are well controlled on and tolerant of their current biologic therapy may be switched to alternative biologics, despite limited evidence supporting this practice. Clinical research and experience suggest that TNF antagonists are not interchangeable, as meaningful differences have been observed in their efficacy and safety profiles. Additional research is needed to assess the risk:benefit ratio of specific sequences of biologic therapies and the validity of switching biologic therapies for nonclinical purposes.

Keywords::

• biologic therapy
• effectiveness
• rheumatoid arthritis
• safety
• switching
• TNF antagonist

Financial & competing interests disclosure

A Reynolds, previously an employee of Pfizer Inc., was a paid consultant to Pfizer in connection with the development of this manuscript. He currently holds Pfizer stock options. A Koenig, E Bananis and A Singh are currently employees of Pfizer Inc. The authors have no other relevant affiliations or financial involvement with abny organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial/medical writing support was provided by Donna McGuire at UBC Scientific Solutions and was funded by Pfizer Inc.