For many people with chronic medical conditions like rheumatoid arthritis (RA), making the decision to change a treatment plan or switch a medication may not be easy.
But, a new study shows that it may be beneficial — or at least not harmful — for people to change up their RA meds now and then, even if done “on the fly.”
Researchers from the University of Vienna concluded that a direct drug switch may not be problematic. In fact, it presented the idea that two RA medications within the same drug class may carry the same efficacy among the general population of people with RA.
They cautioned that an individual’s response to any drug may vary. And people with RA are unique and affected by different circumstances, genetic predispositions, bio-individual makeup, and comorbid conditions.
But making the decision to switch from one biologic to another biologic in the same class may not be harmful, researchers said.
Indeed, the person with RA may actually respond better to the switch than they would if they had remained on the same drug.
Making the switch
The study showed that if a particular RA treatment is failing or proven ineffective, a person with RA may benefit from a sudden switch from one drug to another if the transition is seamless and there is no downtime during the switch.
According to the study, “40 percent of patients responded positively to the new drug. This could result in a paradigm shift in the treatment of rheumatoid arthritis.”
The study involved 1,000 volunteers who had RA.
The participants were on two different anti-TNF drugs, a class of biologics also known as TNF-inhibitors, which are used to treat autoimmune diseases like RA.
The volunteers were split into two groups based on which medication they were taking. Both groups took methotrexate along with their anti-TNF drug.
According to the Medical University of Vienna, “The volunteers in both groups displayed similar responses to the drugs after 12 and 104 weeks, thereby demonstrating that they are equally effective. However, the study volunteers who had not experienced any beneficial effect after 12 weeks [primary treatment failure] switched to the other drug — but, this time, without first discontinuing the previous drug for an extended period. This ‘immediate’ switchover nevertheless brought about a measurable improvement of the condition in 40 percent of volunteers — and a very good 1 in 10 percent.”
This method is unusual in the sense that people with RA often have a “weaning off” period of slowly discontinuing a drug instead of making an immediate switch, which this group of researchers called an “on-the-fly” drug switch.
“If treatment fails, it is possible to switch over to a drug of the same class that still has a beneficial effect in many cases,” Josef Smolen, the lead investigator on the study, explained in a press statement.
He and the other researchers found that if treatment with one anti-TNF drug does not bring about any improvement within three months, it is possible, and even may be recommended, to switch over to another comparable drug of the same class immediately.
“This improves the quality of life for patients and saves costs, because ineffective biologic drugs can be discontinued after a short time and replaced by a new one,” he said.
This “no downtime” approach may not be OK with all rheumatologists, but, in general, a three-month trial period of a new biologic is often the recommended window to measure efficacy.
This time frame may vary depending on the medication as well as other clinical and nonclinical factors.
In the United States, the American College of Rheumatology often has the most current diagnostic guidelines and treatment criteria.