Background: Efficacy of switching of anti-tumour necrosis factor (anti-TNF) in ankylosing spondylitis (AS) in real clinical practice is not fully known.
Objective: The aim of the study was to compare efficacy of the first and the second course of anti-TNF in patients with AS using data from ATTRA.
Material and methods: Patients fulfilled criteria of CRS for indication of anti-TNF. Outcomes used: BASDAI, C-reactive protein (CRP) (mg/l), enthesitis index and survival on drug during 1 year.
Results: In total 1175 patients were included, of whom 1012 had received the first course of anti-TNF only (“non-switchers”), and 163 the second anti-TNF course (“switchers”). Survival during 1–4 years in “non-switchers” was 91%, 86%, 81% and 78% and in switchers 81%, 69%, 60%, 48%. Decrease of CRP was greater in the non-switcher group than in the switcher group in all measured intervals. However, there was not a different proportion of patients who reached BASDAI < 4 in both groups.
Conclusions: This study shows that the second anti-TNF therapy in AS is only a little bit less effective than the 1^st anti-TNF and that switching of therapy is reasonable. 80% and 70% of the patients remain on the second anti-TNF after 1 and 2 years, approximately half of the patients reach major clinical response and the same proportion of patients reach low activity corresponding to a partial remission.