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How good is to switch between biologics? A systematic review of the literature

Loreto Carmona1, Ana Ortiz, Miguel Angel Abad

  • 1Unidad de Investigación, Fundación Espanola de Reumatología, Madrid, Spain. lcarmona@ser.es

Acta Reumatologica Portuguesa
|June 19, 2007
PubMed
Abstract

Insights

Switching TNF-antagonists offers clinical benefits, particularly when the initial drug causes adverse events. However, effectiveness may decrease compared to first-line biologic therapy.

Area of Science:

  • Rheumatology
  • Immunology
  • Pharmacology

Background:

  • Tumor necrosis factor (TNF)-antagonists are widely used for inflammatory diseases.
  • Switching between TNF-antagonists is common, but clinical evidence supporting optimal strategies is limited.

Purpose of the Study:

  • To systematically review the literature on switching TNF-antagonists.
  • To evaluate the clinical outcomes and effectiveness of switching TNF-antagonist therapies.

Main Methods:

  • A systematic literature search was conducted using Medline and Embase databases.
  • Included studies focused on switching TNF-antagonists in human subjects, with a search limit of March 1st, 2007.
  • 33 studies were included from an initial 256 hits and 13 abstracts.

Main Results:

  • Switches between etanercept and infliximab were most frequently studied.
  • The quality of evidence varied, with 5 prospective cohorts, 1 randomized trial, and 1 phase IV trial.
  • Switched therapies generally showed lower effect sizes than first-line biologics, except when switching due to adverse events.

Conclusions:

  • Switching TNF-antagonists yields promising but not excellent results.
  • Effectiveness is reduced compared to initial biologic therapy, especially between monoclonal antibodies.
  • Switching due to adverse events demonstrated high response rates; alternative biologics may be preferable for primary failure.

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