Treatment Sequences After Discontinuing a Tumor Necrosis Fac
A Study was conducted to evaluate the sequences of tumor necrosis factor inhibitors (TNFi) and non-TNFi used by rheumatoid arthritis (RA) patients whose initial TNFi therapy has failed, and to evaluate effectiveness and costs.

Researchers analyzed claims of commercially insured adult patients with RA who switched to their second biologic or targeted disease-modifying antirheumatic drug. The primary outcome was the frequency of treatment sequences. The secondary outcomes were the time to therapy discontinuation, drug adherence, and drug and other health care costs.

--Among 10,442 RA patients identified, 36.5% swapped to a non-TNFi drug, most commonly abatacept (54.2%).

--The remaining 63.5% cycled to a second TNFi, most commonly adalimumab (41.2%). For subsequent switches of therapy, non-TNFi were more common.

--Patients who swapped to a non-TNFi were significantly older and had more comorbidities than those who cycled to a TNFi.

--Survival analysis showed a longer time to discontinuation for non-TNFi than for TNFi when used after initial TNFi discontinuation, but no difference in subsequent switches of therapy.

Finally, while patients are more likely to cycle to a second TNFi than to switch to a non-TNFi, those who switch to a non-TNFi are more likely to stick with the treatment. Cycling to a TNFi, on the other hand, is the less expensive option.