Second-line biologic therapy optimization in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis

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Second-line biologic therapy optimization in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis
Key Take-Away: 

Second line biologic therapy is preferred for patients suffering from rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). The presented systematic review focuses on anti-tumor necrosis factor (TNF) therapy as criteria to comparatively analyze the efficacy of different second line biologic therapies in the treatment of RA, spondyloarthritis (SpA), and PsA. The severity of psoriasis and the predominance of enthesitis and/or dactylitis may drive the choice toward ustekinumab or secukinumab in PsA, and the latter in AS.

The Italian board for the Tailored Biologic therapy (ITABIO) reviewed the most consistent literature to indicate the best strategy for the second-line biologic choice in patients with RA, SpA, and psoriatic arthritis PsA.

ABSTRACT: 
Background: 

The Italian board for the Tailored Biologic therapy (ITABIO) reviewed the most consistent literature to indicate the best strategy for the second-line biologic choice in patients with RA, SpA, and

The Italian board for the Tailored Biologic therapy (ITABIO) reviewed the most consistent literature to indicate the best strategy for the second-line biologic choice in patients with RA, SpA, and psoriatic arthritis PsA.

Methods: 

A systematic review of the literature to identify English-language articles on the efficacy of second-line biologic choice in RA, PsA, and AS was conducted.

Data was extracted from the available randomized controlled trials, national biologic registries, national health care databases, post-marketing surveys, and open-label observational studies.

Results: 

Some previously stated variables, including the patients׳ preference, the indication for anti- TNF monotherapy in potential childbearing women. The intravenous route with dose titration in obese patients resulted valid for all the three rheumatic conditions.

In RA, golimumab as a second-line biologic has the highest level of evidence in anti-TNF failure. The switching strategy is preferable for responders who experience an adverse event, whereas serious or class-specific side effects should be managed by choice of a differently targeted drug. Secondary inadequate response to etanercept (ETN) should be treated with a biologic agent other than anti-TNF. After two or more anti-TNF failures, the swapping to a different mode of action is recommended. Among non-anti-TNF targeted biologics, to date rituximab (RTX) and tocilizumab (TCZ) have the strongest evidence of efficacy in the treatment of anti-TNF failures. In PsA and AS, patients failing the first anti-TNF, the switch strategy to a second is advisable, taking into account the evidence of adalimumab efficacy in patients with uveitis. The severity of psoriasis, of articular involvement, and the predominance of enthesitis and/or dactylitis may drive the choice toward ustekinumab or secukinumab in PsA, and the latter in AS.

Conclusion: 

Taking in account the paucity of controlled trials, second-line biologic therapy may be reasonably optimized in patients with RA, SpA, and PsA.

Source:

Taking in account the paucity of controlled trials, second-line biologic therapy may be reasonably optimized in patients with RA, SpA, and PsA.

Source:

Seminars in Arthritis and Rheumatism

Link to the source:

http://www.semarthritisrheumatism.com/article/S0049-0172(17)30062-8/fulltext?rss=yes

The original title of the article:

Second-line biologic therapy optimization in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis

Authors:

Fabrizio Cantini et al.

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