Switching TNF-alpha antagonists in rheumatoid arthritis: the experience of the LORHEN registry

New biologic agents have changed the paradigm of rheumatoid arthritis treatment, leading to improvement in managing patients' refractory to classical DMARDs. Anti-TNF-alpha is used as first-line treatment in patients failing to respond to classical DMARDs. However, up to 50% of patients fail to respond to these drugs or develop adverse events leading to treatment discontinuation: in these cases the optimal treatment strategy is still a matter of debate even if trying with a second anti-TNF-alpha is considered a good option. We report data of patients switching from a first to a second anti-TNF-alpha from an Italian registry of patients with rheumatoid arthritis, showing that switching is valuable in patients stopping a first anti-TNFalpha drug. The patients with higher disease activity levels and those stopping the first anti-TNFalpha treatment because of a lack of efficacy are very likely to respond to the second treatment.