Estratégia de troca entre agentes anti-TNF-alfa n？o melhora a capacidade funcional em pacientes com artrite reumatoide de longa evolu？？o

objectives: to assess clinical response after switching between anti-tumor necrosis factor-alpha (anti-tnf-alpha) agents in patients with rheumatoid arthritis (ra). patients and methods: this study included 99 patients diagnosed with ra american college of rheumatology, 1987), on anti-tnf-alpha therapy, to assess the therapeutic response after 24 weeks. switching was performed if, after 12 to 24 weeks, a severe adverse event was reported (toxicity: t) or if no reduction greater than 0.6 in the initial disease activity score 28 (das28) occurred (inadequate response: ir). in case of ir, the patient was considered as primary failure (pf). secondary failure (sf) was defined as loss of response after initial improvement. remission (das28 < 2.6), low disease activity (between 2.61 and 3.2), and functional improvement [increase in the initial health assessment questionnaire (haq) > 0.2] were assessed by use of linear regression analysis. the significance level adopted was p < 0.05. results: switching was performed in 39 (39.4%) patients, especially due to pf (24.3%), sf (35.1%) and t (40.5%). the retention rate of the first agent was 60.1%, and the mean time for switching was 14.2 ± 10.9 months. after switching, a tendency towards a decrease in das28 was observed (4.7 ± 1.4; p = 0.08), but not in the haq (1.2 ± 0.77; p = 0.11). around 43% of the patients achieved good/moderate eular response. the major determinant of switching was a higher initial das28, independent of age, duration of disease, and functional capacity. conclusion: switching between anti-tnf-alpha agents is a valid strategy to control disease activity, despite the low likelihood of remission and no significant improvement in functional capacity