At our Los Angeles Patient Educational Seminar in May 2007, a discussion ensued on the subject of why, if a person does not have a successful response to a TNF-a blocker, do doctors sometimes prescribe a different one.

The basic answer is that the anti-TNF-a therapies (such as Enbrel®, Remicade®, and Humira®) each have a mechanism of action. For example, one targets a molecule floating around in the blood stream acts as decoy receptor and blocks it, while another attacks the molecule sitting on the cell and causes that cell to die.

Thus, no one size fits all. NSAIDs also are all different and not everyone responds stages of the disease and mechanism of the drug. There is a lot of variability.

As reported in the July 2007 issue of Rheumatology News, there was a study presented regarding this issue at the annual meeting of the British Society of Rheumatology. The patients in the study who switched TNF-a therapies due to either adverse reactions or lack of efficacy, 22 of 33 were still on their new anti-TNF-a after 19 months, demonstrating that the second drug was effective.

According to an author of the study, Dr. Jemma Pringle, up to 40% of people do not respond to their first anti-TNF-a therapy.

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