Given the lack of studies concerning the efficacy of a second biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) in patients with rheumatoid arthritis (RA), this study comprising of 620 RA patients provided a reasonable drug survival and primary response for second bDMARDs after stopping initial bDMARDs.

This study aimed to evaluate the outcome of the second bDMARD (non-TNFi i.e rituximab, abatacept or tocilizumab, used individually) and TNFi) following the stop of an initial non-TNFi bDMARD.

Overall, 620 RA patients were recognised who initially began with non-TNFi treatment and later switched to bDMARD (86 patients on ABA, 40 patients on RTX, 67 patients on TCZ and 427 patients on TNFi). For the second bDMARD, drug survival (at half and 1 year), and primary response (at half year) were examined.

About 70% patients remained on the treatment at 6 months after initiation of their second bDMARD and about 50% patients remained on the treatment at 12 months. As per the disease activity score, DAS28, less than 33% of patients were still on their second bDMARD; with low disease activity at a period of 6 months. The corresponding proportion was somewhat higher (40%) in patients whose second bMDARD was a TNFI.

The use of a second bDMARD in RA patients after switching from a non-TNFi bDMARD as first bDMARD leads to a modest drug survival and primary response. Some patients may profit from TNFi when used following the stop of a non-TNFi as first bDMARD.