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Switching to Infliximab Benefits Rheumatoid Arthritis Patients Failing Etanercept: Presented at ACR

By Emma Hitt

NEW ORLEANS, LA -- October 30, 2002 -- Patients with rheumatoid arthritis (RA) who are not responding to etanercept may find that switching to infliximab improves symptoms, a new study suggests.

According to lead author Dr. Karen E. Hansen, with the University of Wisconsin, Madison, United States, patients who fail one TNF-alpha inhibitor might be expected to fail another one too, "but that wasn't the case," she said.

Dr. Hansen and colleagues presented their findings at the 66^th American College of Rheumatology meeting Monday.

From an earlier study they conducted that was designed to investigate the efficacy of leflunomide and infliximab in 93 subjects with RA, the researchers analyzed data from the 20 patients in this study who had previously taken etanercept and had switched to infliximab alone.

Indications for switching therapy to infliximab included lack of efficacy in 17 of the 20 patients, as well as shortage of etanercept, low platelet count, and patient concern regarding risk of infection in the remainder.

Seventeen of the 20 patients reported swollen and tender joint counts immediately before they started taking infliximab. Once they began treatment with infliximab, both the tender joint count and the swollen joint count decreased by 72 percent. Minutes of morning stiffness decreased by 30 percent.

Likewise, patient global assessment improved by 30 percent, and physician global assessment improved by 20 percent, while pain diminished by 84 percent, and mean prednisone requirement decreased by about 50 percent.

According to Dr. Hansen, the effect may be similar when patients switch from infliximab to etanercept, as well. She indicated that when she administered etanercept to one patient who had previously been taking infliximab, the patient, who had severe arthritis, went into remission.

"We are not sure of the mechanism," she said. "But the next step will be to conduct a prospective randomized trial to evaluate this further," she said.

Dr. Hansen also suggested that switching to any of the three TNF-alpha inhibitors (infliximab, etanercept, and Abbott's investigational drug adalimumab [D2E7, Humira]), might improve response in patients.

"Physicians should try this approach in their patients," she advised. "Importantly, side effects appeared to be no different in patients who switched."

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