ABS0322 SWITCHING MECHANISM OF ACTION VS. SECOND TNF INHIBITOR FOLLOWING FAILURE OF A FIRST TNF INHIBITOR IN PATIENTS WITH RHEUMATOID ARTHRITIS: EXPERIENCE FROM THE BIOBADASAR 3.0 NATIONAL REGISTRY

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Background: Cycling versus switching TNF inhibitors in rheumatoid arthritis remains a critical topic of discussion, as these strategies have distinct implications for treatment efficacy, persistence, and patient outcomes following the failure of an initial TNF inhibitor. Objectives: To evaluate, in patients who failed a first TNF inhibitor (TNFi), the difference in survival and persistence of the second biologic agent, whether it is a second TNFi or a drug with a different mechanism of action (MOA). Methods: Data were collected from the BIOBADASAR 3.0 registry, including records up to June 2024. Patients with rheumatoid arthritis (RA) who received a TNFi as first-line treatment and subsequently switched due to inefficacy to either a second TNFi or another biologic drug with a different MOA were selected. Drug survival was assessed in both groups. Results: A total of 331 RA patients were included, 180 (54.4%) switched to another TNFi after failure of the first, and 151 (45.6%) switched to a drug with a different MOA. The RA population was predominantly female (86.1%) with a mean age of 53.9 years (SD 12.5). No significant differences in sociodemographic characteristics and comorbidities were found between those who switched MOA and those who did not. In both groups, the initial TNFi agents were mainly etanercept (46.7% and 49.0%) and adalimumab (28.9% and 34.4%). Among those who received a second TNFi, adalimumab was the most prescribed (32.2%), followed by etanercept (31.7%), certolizumab (23.9%), golimumab (8.3%), and infliximab (3.9%). In the MOA switch group, the drugs used were abatacept (55.0%), IL-6 inhibitors (29.1%), and rituximab (15.9%). During follow-up, 156 (86.7%) of the second TNFi group and 116 (76.8%) of the MOA switch group discontinued the second biologic (p=0.029). The most common reason for discontinuation in both groups was inefficacy, particularly among those who received a second TNFi (59.6% vs 44.8%, p=0.02). The survival of the second biologic was significantly longer in those who switched MOA (Figure 1). In multivariate analysis, patients with a shorter disease duration (HR 0.98, 95% CI 0.97-0.99) and those who switched MOA (HR 0.75, 95% CI 0.59-0.95) had a lower risk of discontinuing the second biologic. Conclusion: In this national cohort of RA patients, while switching to a second TNFi after failure of the first is a valid option, this strategy carries a 25% higher risk of discontinuation, particularly due to inefficacy, compared to switching to a different mechanism of action. REFERENCES: NIL . Acknowledgements: NIL . Disclosure of Interests: Carolina Ayelen Isnardi Abbvie, Pfizer, Janssen, Maria Agustina Alfaro: None declared , Maria Haye Salinas: None declared , María Julieta Gamba: None declared , Edson Velozo: None declared , Guillermo Berbotto: None declared , Mercedes De La Sota: None declared , Ida Elena Exeni: None declared , Rodolfo Nicolas Alvarado: None declared , Graciela Gomez: None declared , Alejandro Brigante: None declared , Verónica Saurit: None declared , Erika Catay: None declared , Gustavo Medina: None declared , Gustavo Citera: None declared , Karin Ingrid Kirmayr: None declared , Silvia Papasidero: None declared , MONICA SACNUN: None declared , Maria Silvia Larroude: None declared , Anastasia Secco: None declared , Nora Aste: None declared , Bernardo Pons-Estel: None declared , Gladys Bovea Castelblanco: None declared , Graciela Rodriguez: None declared , Mercedes Argentina García: None declared , Cecilia Pisoni: None declared , Carla Gobbi: None declared , Yohana Tissera: None declared , Emilia Marta Cavillon: None declared , Verónica Savio: None declared , María Celina de la Vega: None declared , Guillermo Pons-Estel: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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