OBJECTIVES : The aim of this study was to identify the main reasons and strategies of changes in biologic therapies in patients with rheumatoid arthritis (RA) assisted by biologic agents Infusion Center at Federal University in Brazil

METHODS : A cross-sectional study was conducted with retrospective data collection in a sample of patients enrolled in the Brazilian Public Health System, who had biologic drugs substitution during the treatment. We collected data of pharmacist follow-up and medical and clinical records, demographic parameters, as well as reason, strategy and substitution time for each biologic therapy

RESULTS : 326 patients with RA were identified. Among those Of these, 153 had already performed at least one biologic drug change, and were enrolled to this study. There was a higher prevalence of females, with a mean age of 51.6 years old and living in the state capital. There were 258 substitutions between biologics, ranging from one to four substitutions per patient. Anti-TNF was the first biologic choice, with infliximab being the most prescribed (39.9%). In 58.2% of the cases, after discontinuation of the first one, a new anti-TNF was chose. After discontinuation of the second biologic, in 69.3% of the cases a drug of another class was prescribed. Only 14.3% of the patients maintained anti-TNF treatment after the third change. After the fourth change, no patient continued anti-TNF treatment. The first treatment change occurred mostly from one monoclonal antibody to another one. This is a result consistent with the preference for infliximab and adalimumab in the first and second biologic treatment choice, respectively. Most of the biologic substitutions at all stages of treatment occurred because of the secondary failure

CONCLUSIONS : The first treatment substitution occurred mostly from one monoclonal antibody to another one. Most of changes occurred due to secondary failure, followed by adverse events. The study allowed outlining the reasons for replacing biologic therapy in patients with rheumatoid arthritis