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Failure of first anti-TNF agent in Takayasu's arteritis: to switch or to swap?


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

 

  1. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. campochiaro.corrado@hsr.it
  2. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
  3. Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy.
  4. Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and University of Genoa and IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  5. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
  6. Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy.
  7. University of Genoa and IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  8. University of Genoa and IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  9. Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy.
  10. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
  11. University of Genoa and IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  12. Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy.
  13. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

CER14071
2021 Vol.39, N°2 ,Suppl.129
PI 0129, PF 0134
Treatment

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PMID: 33666154 [PubMed]

Received: 26/09/2020
Accepted : 23/11/2020
In Press: 05/03/2021
Published: 19/05/2021

Abstract

OBJECTIVES:
Biologic drugs (bDMARD), especially TNF-α-inhibitors (TNFi), are used in refractory Takayasu’s arteritis (TAK) patients. Up to 23% of patients are switched to a different bDMARD because of inefficacy. No data are available on which strategy is more efficient after TNFi failure. The aim of our study is to evaluate whether a switch or swap strategy should be preferred in TAK patients failing TNFis.
METHODS:
TAK patients treated with a second bDMARD after the failure of the first TNFi were identified from 3 referral centres. Patients were classified as switch if treated with a different TNFi, and swap if treated with a non-TNFi bDMARD. Baseline features were evaluated. Efficacy and safety of the second bDMARD at 6 and 12 months were assessed and a comparison between switch and swap patients was made.
RESULTS:
Twenty-four TAK patients were identified. Eleven patients (46%) were switched and 13 patients (54%) were swapped (12 to tocilizumab, 1 to ustekinumab). Baseline features of patients in the 2 groups were comparable. At 12 months, the second bDMARD was suspended in 4 switch (36%) and in 5 swap (42%) patients. Second biologic drug survival and relapse-free survival were equivalent between the two groups at 6 and 12 months. A vascular worsening was observed in 4 switch (40%) and 2 swap (25%) patients. Severe infections, myocardial infarction, ischemic stroke or cancer were recorded in no patient.
CONCLUSIONS:
Our retrospective study suggests that in first-line TNFi failure TAK patients both switch and swap strategies can be considered suitable approaches.

Rheumatology Article