Avoiding TNF Cycling: When to Switch Drug Classes in Rheumatoid Arthritis

This episode, titled 'Avoiding TNF Cycling: When to Switch Drug Classes in Rheumatoid Arthritis,' featured expert rheumatologist Dr. Julia Buchfuhrer discussing the following critical questions:

Disease-modifying antirheumatic drug (DMARD) and tumor necrosis factor (TNF) cycling is a real and well-documented problem in rheumatoid arthritis (RA), with patients cycling through multiple anti-TNF agents without meaningful improvement. How often are you seeing this, and at what point do you intervene?

Do you think clinicians and payers fully appreciate the clinical and economic cost of secondary non-response in RA?

Dr. Buchfuhrer examined the persistence of TNF cycling in clinical practice despite observational data, including a large-scale study of more than 15,000 patients, showing that most patients who fail one TNF inhibitor are kept on the same drug class rather than switched. She discussed the availability of multiple biologic classes beyond TNF inhibitors and the case for moving across classes rather than cycling within one. She also addressed secondary non-response, describing its emotional toll on patients who had reached remission and then relapsed, and emphasized the importance of weighing long-term persistency data when selecting a therapy to avoid repeat treatment failures.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, 'Comparing JAK Inhibitor Mechanisms of Action in RA Treatment', Dr. Buchfuhrer continues her discussion on rheumatoid arthritis and highlight how biologic and Janus kinase (JAK) inhibitor selection can be tailored to individual patient factors, including the differing receptor selectivity among the three FDA-approved JAK inhibitors.