Which anti-TNF is most effective for my patient? Which one should I choose?

Abstract

Background/Aim: Multicenter controlled studies were conducted on the effect of anti-Tumor Necrosis Factor (TNF) agents in rheumatoid arthritis (RA) and varying effectiveness rates were reported. These agents have different advantages over each other. We aimed to compare the disease activation parameters in patients with RA at the beginning and the 52nd week of therapy in patients who were followed up in our center and started on anti-TNF (etanercept, adalimumab, and golimumab), and examine the effects of the drugs that are used by comparing them with each other. Methods: This retrospective cohort study included 187 patients with RA who were started on anti-TNF therapy because the disease activity could not be controlled by the concomitant use of at least three different conventional Disease-Modifying Anti-Rheumatic drugs, and whose adequate response to anti-TNF were observed at the 12th-week follow-up. RA disease activity was measured using the 28-joint Disease Activity Score incorporating erythrocyte sedimentation rate (DAS-28 ESR) and the patients were evaluated by a Health Assessment Questionnaire (HAQ). For each drug group, disease activation and laboratory parameters were compared before treatment initiation and at 52 weeks of treatment. These values were then compared between the drug groups. Results: The mean age of 187 patients included in the study was 52.70 (10.17) years, 119 (63.6%) were female and 68 (36.4%) were male. Of the patients, 63 (33.7%) were using adalimumab, 62 (33.2%) were using etanercept and 62 (33.2%) were using golimumab. In all patients, there was a significant improvement in all parameters except mean corpuscular hemoglobin, gamma-glutamyl transferase, and creatinine. There were significant changes in hemoglobin, leukocyte and platelet count, erythrocyte sedimentation rate, C reactive protein, neutrophil count, serum albumin, DAS-28 ESR, and HAQ levels in all three groups (P<0.05). Conclusion: There were no differences in efficacy between adalimumab, etanercept and golimumab therapies, which were planned considering the comorbidities and drug preferences of the patients. In addition to controlled studies, real-life data to be reported by rheumatology centers will help us obtain more accurate information about the therapy results of anti-TNF agents.

Keywords

• Rheumatoid Arthritis
• Adalimumab
• Etanercept
• Golimumab

References

1. 1. Cross M, Smith E, Hoy D, Carmona L. The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. 2014;73:1316-22. doi: 10.1136/annrheumdis-2013-204627. Epub 2014 Feb 18. PubMed PMID: 24550173.
2. 2. Kitas GD, Gabriel SE. Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. Annals of the rheumatic diseases. 2011;70:8-14. doi: 10.1136/ard.2010.142133. Epub 2010 Nov 24. PubMed PMID:21109513.
3. 3. Sokka T, Kautiainen H, Pincus T, Verstappen SM, Aggarwal A, Alten R, et al. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther. 2010;12:R42. doi: 10.1186/ar2951. Epub 2010 Mar 12. PubMed PMID: 202260118 PubMed Central PMCID: 2888189.
4. 4. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Annals of the rheumatic diseases. 2010;69:1580-8. doi: 10.1002/art.27584.
5. 5. Smolen JS, Aletaha D. Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. Nat Rev Rheumatol. 2015;11:276-89. doi: 10.1038/nrrheum.2015.8. PubMed PMID:25687177.
6. 6. Nam JL, Ramiro S, Gaujoux-Viala C, Takase K, Leon-Garcia M, Emery P, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Annals of the rheumatic diseases. 2014;73:516-28. doi: 10.1136/annrheumdis-2013-204577. Epub 2014 Jan 7. PubMed PMID: 24399231.
7. 7. Gaujoux-Viala C, Nam J, Ramiro S, Landewé R, Buch MH, Smolen JS, et al. Efficacy of conventional synthetic disease-modifying antirheumatic drugs, glucocorticoids and tofacitinib: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Annals of the rheumatic diseases. 2014;73:510-5. doi: 10.1136/annrheumdis-2013-204588. Epub 2014 Jan 6. PubMed PMID: 24395555 PubMed Central PMCID:PMC3932966.
8. 8. Ramiro S, Gaujoux-Viala C, Nam JL, Smolen JS, Buch M, Gossec L, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Annals of the rheumatic diseases. 2014;73:529-35. doi: 10.1136/annrheumdis-2013-204575. Epub 2014 Jan 8. PubMed PMID: 24401994.

9. 9. Stoffer MA, Schoels MM, Smolen JS, Aletaha D, Breedveld FC, Burmester G, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update. 2016;75:16-22. doi: 10.1136/annrheumdis-2015-207526. Epub 2015 May 19. PubMed PMID: 2590290 PubMed Center PMCID: PMC4717391.
10. 10. Fraenkel L, Bathon JM, England BR. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. 2021;73:924-39. doi: 10.1002/acr.24596. Epub 2021 Jun 8. PubMed PMID: 34101387.
11. 11. Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M, et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis and rheumatism. 2005;52:3403-12. doi: 10.1002/art.21386. PubMed PMID: 16255017.
12. 12. Thomas SS, Borazan N, Barroso N, Duan L, Taroumian S, Kretzmann B, et al. Comparative Immunogenicity of TNF Inhibitors: Impact on Clinical Efficacy and Tolerability in the Management of Autoimmune Diseases. A Systematic Review and Meta-Analysis. BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy. 2015;29:241-58. doi: 10.1007/s40259-015-0134-5. PubMed PMID:26280210.
13. 13. Sidiropoulos PI, Boumpas DT. Differential drug resistance to anti-tumour necrosis factor agents in rheumatoid arthritis. Annals of the rheumatic diseases. 2006;65:701-3. doi: 10.1136/ard.2005.049890. PubMed PMID: 16699049 PubMed Centre PMCID: PMC1798160.
14. 14. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis and rheumatism. 2010;62:2569-81. doi: 10.1002/art.27584. PubMed PMID: 20872595.
15. 15. Pereira AM, Tiemensma J, Romijn JA. Neuropsychiatric Disorders in Cushing’s Syndrome. Neuroendocrinology. 2010;92(suppl 1):65-70. doi: 10.1159/000314317. Epub 2010 Sep 10. PubMed PMID: 20829621.
16. 16. Celik S, Yazici Y, Yazici H. Are sample sizes of randomized clinical trials in rheumatoid arthritis too large? European journal of clinical investigation. 2014;44:1034-44. doi: 10.1111/eci.12337. Epub 2014 Oct 7. PubMed PMID: 25207845.
17. 17. Li P, Zheng Y, Chen X. Drugs for Autoimmune Inflammatory Diseases: From Small Molecule Compounds to Anti-TNF Biologics. Frontiers in Pharmacology. 2017;8. doi: 10.3389/fphar.2017.00460. eCollection 2017. PubMed PMID:28785220 PubMed Center PMCID: PMC5506195.
18. 18. Moudgil KD, Choubey D. Cytokines in autoimmunity: role in induction, regulation, and treatment. Journal of interferon & cytokine research : the official journal of the International Society for Interferon and Cytokine Research. 2011;31:695-703. doi: 10.1089/jir.2011.0065. Epub 2011 Sep 23. PubMed PMID: 21942420 PubMed Centre PMCID: PMC3189547.
19. 19. Tracey D, Klareskog L, Sasso EH, Salfeld JG, Tak PP. Tumor necrosis factor antagonist mechanisms of action: a comprehensive review. Pharmacology & therapeutics. 2008;117:244-79. doi: 10.1016/j.pharmthera.2007.10.001. Epub 2007 Oct 26. PubMed PMID: 18155297.
20. 20. Atzeni F, Turiel M, Capsoni F, Doria A, Meroni P, Sarzi-Puttini P. Autoimmunity and Anti-TNF-α Agents. Annals of the New York Academy of Sciences. 2005;1051:559-69.
21. 21. Shealy DJ, Cai A, Staquet K, Baker A, Lacy ER, Johns L, et al. Characterization of golimumab, a human monoclonal antibody specific for human tumor necrosis factor α. mAbs. 2010;2:428-39. doi: 10.4161/mabs.12304. Epub 2010 Jul 1. PubMed PMID: 20519961 PubMed Centre PMCID: PMC: 3180089.
22. 22. Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet (London, England). 2007;370:1861-74. doi: 10.1016/S0140-6736(07)60784-3. PubMed PMID: 17570481.
23. 23. Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis and rheumatism. 2006;54:26-37. doi: 10.1002/art.21519. PubMed PMID: 16385520.
24. 24. Kavanaugh A, Fleischmann RM, Emery P, Kupper H, Redden L, Guerette B, et al. Clinical, functional and radiographic consequences of achieving stable low disease activity and remission with adalimumab plus methotrexate or methotrexate alone in early rheumatoid arthritis: 26-week results from the randomised, controlled OPTIMA study. Annals of the rheumatic diseases. 2013;72:64-71. doi: 10.1136/annrheumdis-2011-201247. PubMed PMID: 22562973 PubMed Centre PMCID: PMC3551224.
25. 25. Keystone EC, Kavanaugh AF, Sharp JT, Tannenbaum H, Hua Y, Teoh LS, et al. Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial. Arthritis and rheumatism. 2004;50:1400-11. doi: 10.1002/art.20217. PubMed PMID: 15146409.
26. 26. Klareskog L, van der Heijde D, de Jager JP, Gough A, Kalden J, Malaise M, et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet (London, England). 2004;363:675-81. doi: 10.1016/S0140-6736(04)15640-7. PubMed PMID: 15001324.
27. 27. Emery P, Fleischmann RM, Moreland LW, Hsia EC, Strusberg I, Durez P, et al. Golimumab, a human anti-tumor necrosis factor alpha monoclonal antibody, injected subcutaneously every four weeks in methotrexate-naive patients with active rheumatoid arthritis: twenty-four-week results of a phase III, multicenter, randomized, double-blind, placebo-controlled study of golimumab before methotrexate as first-line therapy for early-onset rheumatoid arthritis. Arthritis and rheumatism. 2009;60:2272-83.
28. 28. Keystone E, Genovese MC, Klareskog L, Hsia EC, Hall S, Miranda PC, et al. Golimumab in patients with active rheumatoid arthritis despite methotrexate therapy: 52-week results of the GO-FORWARD study. Annals of the rheumatic diseases. 2010;69:1129-35. doi: 10.1136/ard.2009.116319. Epub 2010 May 5. PubMed PMID: 20444749.
29. 29. Smolen JS, Kay J, Doyle MK, Landewé R, Matteson EL, Wollenhaupt J, et al. Golimumab in patients with active rheumatoid arthritis after treatment with tumour necrosis factor alpha inhibitors (GO-AFTER study): a multicentre, randomised, double-blind, placebo-controlled, phase III trial. Lancet (London, England). 2009;374:210-21. doi: 10.1016/S0140-6736(09)60506-7. Epub 2009 Jun 26. PubMed PMID: 19560810.