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Does the Type of Failure and the Choice of the Second Biologic Influence Response and Persistence on Medication in
Louis Bessette1, Mohammad Movahedi2, George Reed3
1From the Centre de Recherche du CHU de Québec-Université Laval, Québec, Québec.
Background:
The type of failure may predict response to a second biologic. We evaluated the response to a second tumor necrosis factor inhibitor (TNFi) or non-TNFi in patients failing their initial TNFi, either primarily or secondarily.
Methods:
Patients with rheumatoid arthritis who were biologic-naive and had a Clinical Disease Activity Index (CDAI) >10, who started their first TNFi for ≥3 months and then switched to a second biologic, were included in the study. Secondary failure was defined as 2 consecutive low-CDAI visits and then switching to a second biologic while they had moderate/severe CDAI. Primary failure was defined if it did not meet the definition of secondary failure, or if they had at least 1 moderate/severe CDAI after 3 months on treatment. We used multivariable logistic regression comparing primary versus secondary failure for achievement of CDAI ≤10 (primary outcome) and minimal clinically important differences (secondary outcome) at 6 months after switch.
Results:
Of the 462 patients included, 64.3% and 35.7% stopped the first TNFi because of a primary and secondary failure, respectively. Patients with primary failure had a more severe disease (CDAI mean, 26.39 vs. 21.61; p < 0.001). The likelihood of achieving CDAI ≤10 (odds ratio, 4.367; 95% confidence interval, 2.428-7.856) and minimal clinically important difference (odds ratio, 2.851; 95% confidence interval, 1.619-5.020) was significantly higher for secondary than primary failure regardless of choice of a second agent.
Conclusion:
Patients with rheumatoid arthritis with secondary failure to a first TNFi responded better to a second biologic agent, regardless of the choice of biologic.
Insights
Patients with rheumatoid arthritis who failed initial biologic therapy responded better to a second biologic agent if they experienced secondary failure versus primary failure. This finding held true regardless of the second biologic chosen.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Understanding treatment failure in rheumatoid arthritis (RA) is crucial for optimizing subsequent therapies.
- The type of failure to an initial biologic therapy may predict response to a second-line agent.
Purpose of the Study:
- To evaluate the response to a second tumor necrosis factor inhibitor (TNFi) or non-TNFi in RA patients who failed their initial TNFi.
- To compare outcomes based on whether the initial TNFi failure was primary or secondary.
Main Methods:
- Retrospective analysis of biologic-naive RA patients with high disease activity (Clinical Disease Activity Index [CDAI] >10).
- Patients switched to a second biologic after failing a first TNFi for at least 3 months.
- Primary failure defined by persistent moderate/severe disease activity; secondary failure by initial response followed by loss of efficacy.
Main Results:
- Of 462 patients, 64.3% had primary failure and 35.7% had secondary failure to the first TNFi.
- Patients with primary failure exhibited more severe disease (mean CDAI 26.39 vs. 21.61).
- Secondary failure was associated with significantly higher odds of achieving CDAI ≤10 (OR 4.367) and minimal clinically important difference (OR 2.851) at 6 months post-switch.
Conclusions:
- Rheumatoid arthritis patients experiencing secondary failure to a first TNFi demonstrate superior response to a second biologic agent.
- Treatment outcomes with a second biologic are better predicted by the pattern of initial failure (secondary vs. primary).
- The choice of the second biologic agent did not alter the improved response observed in secondary failure cases.
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