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Switching TNFα inhibitors: Patterns and determinants
Rosanne W Meijboom1,2, Helga Gardarsdottir2,3,4, Matthijs L Becker1,5
1Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands.
Approximately one in six patients switched TNFα-inhibitor (TNFα-i) therapy, primarily to another TNFα-i. Key factors influencing switching included dose escalation and high-dose corticosteroid use in rheumatic diseases and inflammatory bowel disease patients.
Area of Science:
- Rheumatology
- Gastroenterology
- Dermatology
Background:
- Tumor Necrosis Factor-alpha inhibitors (TNFα-i) are crucial for managing rheumatic diseases (RD), inflammatory bowel disease (IBD), and psoriasis.
- Understanding treatment switching patterns is vital for optimizing patient outcomes and resource allocation.
Purpose of the Study:
- To evaluate switching patterns among patients initiating TNFα-inhibitor therapy.
- To identify determinants associated with switching biological treatments in RD, IBD, and psoriasis patients.
Main Methods:
- Retrospective cohort study of 2228 patients initiating TNFα-i between 2012-2017 in three Dutch hospitals.
- Analysis included switching incidence, patterns, and logistic regression to identify determinants for the first switch.
Main Results:
- Overall, 16.6% of RD, 14.5% of IBD, and 16.0% of psoriasis patients switched therapy, predominantly to another TNFα-i.
- In RD, TNFα-i dose escalation and high-dose corticosteroid initiation were significant predictors of switching.
- For IBD, determinants included TNFα-i dose escalation, immunomodulator use, high-dose corticosteroids, and serum concentration monitoring.
Conclusions:
- Switching biological treatment is common, affecting about one in six patients.
- Specific clinical factors like dose escalation and corticosteroid use predict switching in RD and IBD patients.
- These insights can aid clinicians in anticipating and managing treatment switches for patients on TNFα-inhibitors.
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