Switching between anti-tumour necrosis factors: trying to get a handle on a complex issue.

摘要

The registration, almost simultaneously, of etanercept and infiiximab, followed some years later by that of adalimumab, presented rheumatologists with outstanding therapeutic options to the benefit of many patients. Nevertheless, it also became clear that none of these drugs are effective in all cases, and the question about switching from one anti-tumour necrosis factor (TNF) to another became an important clinical issue. As we wrote 4 years ago in the Annals of the Rheumatic Diseases: "in these situations, [is] there a rationale for prescribing the other TNFa blocker, or [is this] simply a waste of time and money?". Since that publication, a sizeable number of research articles have investigated this question, and the answers have generally been in the affirmative, implying that, yes, a switch of this type can benefit some patients. However, some reports reached less favourable conclusions, and it can rightfully be asserted that none of those published studies, nor any of the many abstracts presentedat international meetings on the topic, were controlled, prospective, randomised or blinded.