THU0298 SWITCH OR SWAP STRATEGY IN TAKAYASU ARTERITIS PATIENTS FAILING TNFA INHIBITORS?
Authors: C. Campochiaro, E. Galli, E. Cocchiara, A. Tomelleri, S. Sartorelli, F. Muratore, M. G. Catanoso, E. Baldissera, A. Ravelli, C. Salvarani, L. Dagna
Journal: Annals of the Rheumatic Diseases (2020)

Background: biologic drugs (bDMARD), especially anti-TNFα (TNFi), are used in refractory TA patients. Up to 60% of patients are eventually switched to a different bDMARD because of inefficacy. No data are available on which strategy (switch or swap) is more efficient in this setting. Objectives: to evaluate whether switch or swap strategy can be more effective in TA patients failing TNFis. Methods: TA patients treated with bDMARDs after TNFi failure were identified from 3 referral centres. Patients were classified as “switch” if treated with a different TNFi (infliximab, IFX, etanercept, ETN, golimumab, GOL, adalimumab, ADA) or “swap” if treated with a non-TNFi bDMARD (tocilizumab, TCZ, ustekinumab, USK). Baseline features and disease outcome (number of patients with NIH score &lt;2, steroid dose reduction (SDR), disease relapses and vascular interventions) at month 6 and month 12 after 2 nd bDMARD introduction were analyzed. Non parametric tests were used. Results: 24 TA patients were identified. TNFi (IFX= 13; ADA= 8; ETN= 1; GOL= 2) was withheld after a median of 19 (8.5; 38) months (in 9 patients &lt;12 months) for inefficacy in 19 (79%) patients and side effects in 5 (21%) patients. 11 (46%) patients were switched and 13 (54%) patients were swapped (12 to TCZ, 1 to USK). Baseline features at 2 nd bDMARD start are summarized in Table 1. 2 nd bDMARD retention at month 6 was comparable between switch (8, 73%) and swap (10, 77%) patients, p=1. Reasons for discontinuation were: inefficacy in 5 patients, allergic reaction in 1 switch patient. 5 (45%) switch and 6 (46%) swap patients had a NIH&lt;2 (p=1). Median SDR was similar: 3.75(0-19.69) in swap and 4.37(1.87-10) mg daily in switch, p=0.829. Also at month 12, 2 nd bDMARD retention was comparable: 7 (64%) switch vs 7 (54%) swap, p=0.210. Discontinuation reason was inefficacy in all cases. 6 (54%) switch and 4 (30%) swap patients had a NIH&lt;2 (p=0.222). Median SDR from baseline was 3.75(0.62-7.5) in switch and 1.25 (0-6.25) in swap,p=0.620. 12 patients experienced a relapse within the first year: 10 (77%) swap and 2 (18%) switch patients, p=0.074. 3 patients underwent vascular interventions within the first year: 2 (18%) switch and 1 (8%) swap patient, p=0.576. Table 1. Disease features of switch and swap TA patients at 2nd bDMARD start. Switch (11 patients ) Swap (13 patients ) p value Age (years ) 39 (31-54) 37 (32-46) 0.613 Sex (female,% ) 82 100 0.199 Numano - I 2 1 - IIa 2 2 - IIb 1 1 - III 1 1 - IV 0 2 - V 5 6 Disease duration (years ) 4 (2 -6) 3 (2 – 8) 0.743 Previous csDMARD (% ) 91 100 0.458 TNFi duration (months ) 25 (9 – 27) 16 (9 – 44) 0.813 Steroid dose (mg daily ) 15 (8.75 – 22.5) 15 (10 – 25) 0.726 Current csDMARD, n(% ) 10 (91) 9 (70) 0.327 - Methotrexate 6 6 - Azathioprine 1 2 - Sirolimus 1 0 - Salazopyrin 0 1 - Cyclophosphamide 1 0 - Mycofenolate 1 0 NIH ≥2 (% ) 73 61 0.679 CRP (mg/L ) 34 (14 – 73) 24 (10 – 45) 0.604 ESR (mm/1h ) 43 (35 – 56) 51 (35 – 68) 0.729 Conclusion: our retrospective study suggests that in first-line TNFi failure TA patients both switch and swap strategies are seemingly effective. Disclosure of Interests: Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Elena Galli: None declared, Emanuele Cocchiara: None declared, Alessandro Tomelleri: None declared, Silvia Sartorelli: None declared, Francesco Muratore: None declared, Maria Grazia Catanoso: None declared, Elena Baldissera Speakers bureau: Novartis, Pfizer, Roche, Alpha Sigma, Sanofi, Angelo Ravelli: None declared, Carlo Salvarani: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI