Cycling TNFi, Swapping to Non-TNFi Strategies Offer Similar Functional Disability Improvements in RA

Investigators compared 2 treatment strategies, swapping vs cycling, to examine patient-reported outcomes and functional ability.
The following article is part of conference coverage from the 2018 European League Against Rheumatism (EULAR) Congress in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

Cycling to a second tumor necrosis factor-a inhibitor (TNFi) and swapping to a non-TNFi are 2 different rheumatoid arthritis (RA) treatment strategies associated with similar improvements in functional ability, according to findings from a systematic review and meta-analysis presented at the European League Against Rheumatism (EULAR) Congress, held in Amsterdam, June 13 to 16, 2018.

“Data on patient-reported functional ability to evaluate the optimal strategy for patients who have failed to first TNFis is scarce,” according to the study investigators. “Patient-reported outcomes are a critical component of assessing whether clinicians are improving the wellbeing of patients.”

The researchers reviewed study data from 4 electronic research databases, as well as unpublished records and gray literature sources. Studies included in the meta-analysis were controlled trials that reported data on patient-reported outcomes in patients with RA after swapping to a non-TNFi with a different mechanism of action or after cycling to a second TNFi. In their analysis, investigators evaluated patient-reported outcomes among 4394 patients with RA enrolled in a total of 13 studies. Patient-reported outcomes included functional disability, pain, fatigue, patient global assessment, and quality of life.

Among all 13 studies, the cycling vs swapping TNFi strategies were adalimumab, certolizumab, etanercept, golimumab, or infliximab vs abatacept, rituximab, tocilizumab, or tofacitinib, respectively. In the pooled analysis comparing TNFis vs disease-modifying antirheumatic drugs (DMARDs), investigators found a significant short-term increase in functional ability among patients receiving a cycling strategy (mean difference [MD], −0.20; 95% CI, −0.34 to −0.06; scores ranging from 0 to 3). Additional improvements in functional ability were found for fatigue, pain, and patient global assessment, sleep, and quality of life for cycling strategies.

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The investigators also observed significant improvements in functional ability among patients receiving a swapping strategy in the pooled analysis comparing non-TNFi vs DMARDs (MD, −0.31; 95% CI, −0.35 to −0.27; scores ranging from 0 to 3). In 3 randomized controlled trials, no significant difference between swapping and cycling TNFis were found in regard to functional disability at 12, 24, 36, or 52 weeks (MD at 52 weeks, −0.05; 95% CI, −0.18 to 0.09; score ranging from 0 to 3).

“Although evidence from previous reports suggest that swapping may be more effective than cycling when evaluating some clinical outcomes our results suggest that with the current evidence both strategies are equally effective in improving functional disability and other patient-reported outcomes,” concluded the researchers.

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Lopez-Olivo MA, Matusevich A, Cantor SB, Pratt G, Suarez-Almazor ME. The comparative effectiveness of cycling tumor necrosis factor inhibitor (TNFi) versus swapping to a Non-TNFi on patient-reported functional ability of patients with rheumatoid arthritis. Presented at: European League Against Rheumatism (EULAR) Congress 2018June 13-16, 2018; Amsterdam, The Netherlands. Abstract OP0298.