失败类型可能预测对第二种生物制剂的反应。我们评估了接受第二种肿瘤坏死因子抑制剂（TNFi）或非TNFi治疗的患者对初始TNFi治疗失败的反应，无论是初级失败还是继发性失败。研究对象为类风湿性关节炎患者，没有接受过生物制剂治疗，且临床疾病活动指数（CDAI）>10，先开始使用第一种TNFi治疗≥3个月，然后转为使用第二种生物制剂。继发性失败的定义为患者连续两次CDAI较低后，持续处于中度/重度CDAI状态下转换为第二种生物制剂。初级失败的定义是指没有满足继发性失败的定义，或在治疗3个月后至少有1次中度/重度CDAI的情况。我们采用多变量逻辑回归分析比较初级与继发性失败在转换后6个月达到CDAI≤10（主要结局）和达到最小临床重要差异（次要结局）的比率。 共有462名患者纳入研究，64.3%因初级失败而停用第一种TNFi，35.7%因继发性失败而停用。初级失败患者疾病更为严重（CDAI平均值26.39 vs. 21.61；p < 0.001）。无论选择第二种药物，继发性失败患者达到CDAI≤10（优势比4.367；95%置信区间2.428-7.856）和实现最小临床重要差异（优势比2.851；95%置信区间1.619-5.020）的可能性显著高于初级失败患者。 与初级失败患者相比，对第一种TNFi失败的类风湿性关节炎患者对第二种生物制剂的反应更好，无论选择哪种生物制剂。 © 2023 Wolters Kluwer Health, Inc. 保留所有权利。

The type of failure may predict response to a second biologic. We evaluated the response to a second tumor necrosis factor inhibitor (TNFi) or non-TNFi in patients failing their initial TNFi, either primarily or secondarily.Patients with rheumatoid arthritis who were biologic-naive and had a Clinical Disease Activity Index (CDAI) >10, who started their first TNFi for ≥3 months and then switched to a second biologic, were included in the study. Secondary failure was defined as 2 consecutive low-CDAI visits and then switching to a second biologic while they had moderate/severe CDAI. Primary failure was defined if it did not meet the definition of secondary failure, or if they had at least 1 moderate/severe CDAI after 3 months on treatment. We used multivariable logistic regression comparing primary versus secondary failure for achievement of CDAI ≤10 (primary outcome) and minimal clinically important differences (secondary outcome) at 6 months after switch.Of the 462 patients included, 64.3% and 35.7% stopped the first TNFi because of a primary and secondary failure, respectively. Patients with primary failure had a more severe disease (CDAI mean, 26.39 vs. 21.61; p < 0.001). The likelihood of achieving CDAI ≤10 (odds ratio, 4.367; 95% confidence interval, 2.428-7.856) and minimal clinically important difference (odds ratio, 2.851; 95% confidence interval, 1.619-5.020) was significantly higher for secondary than primary failure regardless of choice of a second agent.Patients with rheumatoid arthritis with secondary failure to a first TNFi responded better to a second biologic agent, regardless of the choice of biologic.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.