RA Stop the Cycle

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Experts Discuss: ​ Switch vs Cycle​

Video

Dr. Roy Fleischmann and Dr. Janet Pope share clinical perspectives on switching vs cycling in patients with RA after TNFi failure

  •  7-minute watch

The experts

Roy M. Fleischmann, MD

Roy M. Fleischmann, MD

Clinical Professor of Medicine; University of Texas Southwestern

Janet Pope, MD, MPH, FRCPC ​

Professor of Medicine ​ Division of Rheumatology ​ University of Western Ontario​

Key information

For patients with RA who have failed a TNFi, rheumatologists have options when selecting their patient’s next treatment:​

Switch to an alternate MOA

Patients who switched have been observed to have an increased likelihood of achieving response, including LDA and remission, compared to patients who cycled1–3

Cycle to another TNFi

Following secondary TNFi non-response, up to 60% of patients who cycled to another TNFi have been observed to achieve ACR204–6

Treatment considerations for your ​patients with RA after TNFi failure4,7

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Reason for TNFi failure: primary vs secondary non-response

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Individual patient preference and lifestyle

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Patient comorbidities and concomitant medications

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For a patient who is a primary TNFi non-responder, would you be more likely to switch or cycle?

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For a patient with an initial TNFi response but a later secondary loss of response, would you be more likely to switch or cycle?

Resource

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Find out more about switching vs cycling in patients with RA after first TNFi failure

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ACR20, improvement of ≥20% in American College of Rheumatology core criteria; LDA, low disease activity; MOA, mechanism of action; RA, rheumatoid arthritis; TNFi, tumor necrosis factor inhibitor.

  1. Gottenberg JE et al. JAMA. 2016;316(11):1172–1180.
  2. Bogas P et al. Ther Adv Musculoskelet Dis. 2021;13:1759720X211060910.
  3. Wei W et al. Adv Ther. 2017;34(8):1936–1952.
  4. Taylor PC et al. Ther Adv Musculoskelet Dis. 2022;14:1759720X2211141.
  5. Smolen JS et al. Lancet 2016.; 388:2763–2774.
  6. Smolen JS et al. Ann Rheum Dis. 2012;71:1671–1679.
  7. Johnson KJ et al. Clin Rheumatol. 2019;38(11):2967–2976.
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