Rotation or Change of Biotherapy After TNF Blocker Treatment Failure for Axial Spondyloarthritis
Status:
Recruiting
Trial end date:
2023-11-01
Target enrollment:
Participant gender:
Summary
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease characterized by
inflammatory arthritis and enthesitis involving the spine. AxSpA prevalence is around 0.17%
of the French population. Tumor necrosis factor (TNF) was the first target defined in axSpA.
Since one third of axSpA patients failed to the first TNF blocker, many axSpA patients
received a second biological Disease-Modifying AntiRheumatic Drugs (bDMARDs). Until few
months, the only choice was to use a second TNF blocker.Since 2003, pharmaceutical companies
investigated efficacy of TNF blockers already used in rheumatoid arthritis. Etanercept is a
fusion protein with TNF receptor type II p75 and IgG1 Fc fragment, whereas adalimumab,
infliximab, and golimumab are monoclonal antibodies. Certolizumab is a fusion between a fab
fragment targeting TNF and a Peg fraction. All demonstrated efficacy versus placebo in a
randomized double blinded study
In case of failure to the first TNF blockers, rheumatologists will follow the
"Treat-to-Target" principle. This approach already demonstrated its benefit in rheumatoid
arthritis or in psoriatic arthritis. This concept was also suggested for axSpA with low
levels of evidence and recommendation. So rheumatologist will provide the best treatment in
case of failure to the first TNF blockers, which is a daily clinical situation. Since few
months, rheumatologists have the choice between targeting IL-23/17 axis compared to a second
TNF blocker.