Which Biologic Treatment Should RA Patients Try Next?

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Rheumatoid Arthritis patients will likely try a sequence of 3 or 4 biological therapies. However, odds tend to decrease that the treatments will work. “For patients with prior exposure to TNF-a inhibitors, likelihood of response to subsequent treatment with biologic agents declines with increasing number of previous treatments with TNF-a inhibitors.”

Newsflash: responses to Biologic treatments vary greatly

  1. 1/3 of Rheumatoid Arthritis patients do not respond to currently available biologic treatments.
  2. Most patients eventually stop responding even after a successful response.
  3. Even a so-called successful response is often a 50% reduction in symptoms, with patients still functionally disabled.

screenshot subsequent biologic treatmentsApparently, most people assume that treatments work similarly for all Rheumatoid Arthritis patients. Actually most doctors I’ve talked to have that impression.  I guess it’s hard to imagine a disease so sneaky and evil that treatments only work on some patients.

True, this is one more block in the bridge of awareness that we must build: explaining how greatly new RA treatments are needed. But there are good reasons for the confusion.

  1. It makes sense logically that costly designer drugs would work.
  2. Biologics commercials make it look like we can get our lives back.
  3. Statistics are confusing on how many patients are actually helped by biologic treatments.

Subsequent Biologic TNF treatments are less likely to work

Assessing the likelihood of response to subsequent biologic therapies is the topic of a new article in Arthritis Research and Therapy, “Evaluating the efficacy of sequential biologic therapies for rheumatoid arthritis patients with an inadequate response to tumor necrosis factor-alpha inhibitors.” From the study:

  • The objective of this study was to systematically review and quantitatively evaluate the relationship between clinical response to biologic treatments and number of previous treatments with tumor necrosis factor-alpha (TNF-alpha) inhibitors.
  • Several review studies have attempted to summarize data from these studies but no clear guidance has emerged from these publications… These results suggested that  the probability of achieving a clinical response declines after the first TNF-a inhibitor, a trend that was observed in our study as well, even when the other biologic DMARDs were considered.

Biological musical chairs: working to create a more successful game

Will it always be a stab in the dark when a patient tries a new treatment? Or will we someday have strategies? This study is an important first step:

  • Given that a substantial proportion of patients will fail an initial biologic treatment, establishing when and how to initiate treatment with these agents is just as important as establishing the relative value of long-term treatment strategies. In many instances, these long term strategies involve a sequence of treatments, so the question arises at each step as to which therapy to use as a replacement when a particular therapy must be stopped for inefficacy or intolerance.
  • The exact form of the relationship between response to treatment and number of failed TNF-a inhibitors is likely to play an increasingly important role in defining treatment strategies for RA patients with an inadequate response to treatment with TNF-a inhibitors.

The full study on subsequent biologic treatments is available here in a PDF. I typed out some long quotes, but when you have time, the rest of the PDF is interesting reading.

Recommended reading:

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Kelly Young. All rights reserved.

This entry was posted on Wednesday, February 23rd, 2011 at 5:00 am and is filed under Treating RA. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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