Response to Biologic Disease-Modifying Anti-Rheumatic Drugs after Discontinuation of Anti-Tumor Necrosis Factor Alpha Agents for Rheumatoid Arthritis.

INTRODUCTION: The aim of this study was to compare the response between subsequent use of anti-tumor necrosis factor α (anti-TNF) agents and biologic disease-modifying anti-rheumatic drugs (bDMARD) with other mechanism of action (MOA) in rheumatoid arthritis (RA) patients with history of anti-TNF treatment as their first bDMARD. METHODS: A retrospective chart review was conducted at eight community-based rheumatology practices in the United States in 2012. Routine Assessment of Patient Index Data 3 (RAPID3) response was measured by comparing baseline and 6-month scores. Poor response was defined as decrease <1.8 points, follow-up score >12, or treatment discontinuation before 6 months. Percentages of patients with good and good or moderate RAPID3 response were compared for second and third biologics. Multivariate models controlled for potential confounders. RESULTS: Of 176 patients whose charts were abstracted, 122 (69.3%) received another anti-TNF agent after they discontinued their first anti-TNF. RAPID3 scores were available for 160 patients. A patient receiving a second bDMARD with another MOA had a higher good or moderate response than a patient receiving anti-TNF (53.5 vs. 30.7%, p = 0.01). In the multivariate models, treatment with another MOA was more likely to produce a good RAPID3 response [odds ratio (OR), 2.42; 95% confidence interval (CI), 1.05-5.58] or a good or moderate response (OR, 2.21; 95% CI, 1.23-3.97) than treatment with an anti-TNF. CONCLUSION: In patients who have discontinued anti-TNF agents as their first bDMARD, RAPID3 response rates are better for those receiving agents with a different MOA rather than another anti-TNF. Physicians should consider using a bDMARD with a different MOA as the next bDMARD for RA patients whose anti-TNF agent has failed.

Influence of an educational seminar on use of disease activity measurements by rheumatologists in treatment of rheumatoid arthritis.

OBJECTIVE: To determine the variables underlying clinical decisions made by rheumatologists when treating patients with rheumatoid arthritis (RA), and to determine the effect of an educational seminar on the use of quantitative disease activity measurements in clinical practice in this population of physicians. METHODS: Practicing rheumatologists were surveyed on the variables affecting their clinical management of patients with RA by questionnaire. Physicians were divided into 2 groups: the first comprised attenders (Group A) to an educational seminar in the use of the quantitative disease activity measurements in patient management, while the second group comprised nonattenders (Group NA). Both groups were surveyed on their practice behavior before (Survey 1) and 2 to 3 months after (Survey 2) the seminar. RESULTS: Fifty-two rheumatologists in clinical practice from across the US completed and returned 364 surveys. A significantly greater number of rheumatologists in Group A reported use of disease activity measures following the training seminar (Survey 2), compared to their use pre-meeting and compared to Group NA (p < 0.0001). CONCLUSION: Our results support employment of an educational seminar on the use of disease activity measurements to increase the use of these quantitative measures in rheumatologic practice.

Intra-articular hyaluronans: a review of product-specific safety profiles.

BACKGROUND AND OBJECTIVES: Intra-articular (IA) hyaluronans (HAs) are indicated for pain relief of osteoarthritis (OA) of the knee. Hyalgan (sodium hyaluronate), Supartz (sodium hyaluronate), and Synvisc (hylan G-F 20) are Food and Drug Administration-approved HA products. They are derived from rooster combs; Hyalgan and Supartz are naturally derived (unmodified); Synvisc is chemically modified to increase its molecular weight. This article reviews and updates the safety data for IA HAs used for the treatment of knee OA. METHODS: References were taken from Medline through July 2002; respective product information services and information from the searchable United States Food and Drug Administration Manufacturer and User Facility Device Experience Database also were used. RESULTS: All products demonstrated favorable safety profiles in clinical trials and practice compared to other standard therapies for management of OA knee pain. The most common adverse event associated with HAs is mild injection site pain and swelling. Each product has had rare reports of pseudogout and anaphylactoid reactions. Product-specific adverse events, severe acute inflammatory reactions (pseudoseptic knee), in patients receiving Synvisc have been reported. One such patient developed antibodies to chicken proteins and hylan, suggesting an immunologic basis for the severe acute inflammatory reaction. Data from an animal study support a possible immunogenic difference between Synvisc and Hyalgan. CONCLUSIONS AND RELEVANCE: Overall, HA therapy is a safe treatment for OA knee pain, although there may be interproduct variability in safety profiles.