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Rheumatoid Arthritis
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my personal edition > rheumatoid arthritis > news
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DGReview
Adalimumab, Etanercept, and Infliximab Show Similar Efficacy When Combined with Methotrexate in the Treatment of Rheumatoid Arthritis
A DGReview of :"Comparison of the efficacy of the tumour necrosis factor alpha blocking agents adalimumab, etanercept, and infliximab when added to methotrexate in patients with active rheumatoid arthritis"
Annals of the Rheumatic Diseases (ARD Online)
10/15/2003
By Deanna M Green, PhD
Similar clinical response rates are seen when adalimumab, etanercept, or infliximab are added to methotrexate treatment for rheumatoid arthritis (RA), according to a recent literature review.
The management of RA often includes disease modifying antirheumatic drugs (DMARDs), such as methotrexate. Despite long-term effectiveness in clinical practice, a number of patients continue symptoms of active disease even with methotrexate treatment.
Dr. MC Hochberg and colleagues at the University of Maryland School of Medicine, Baltimore, United States, conducted a literature review to evaluate the efficacy of 3 approved anti-tumour necrosis factor (TNF alpha) agents in combination with methotrexate in the treatment of RA in patients showing an incomplete response to methotrexate alone.
The review included 4 placebo-controlled, double-blind, randomised clinical trials in which patients receiving methotrexate (average dose 16 to 19 mg/week) were given either adalimumab, etanercept, or infliximab in a step-up approach for at least 24 weeks.
Relative risk of American College of Rheumatology (ACR) 20 or 50 response was calculated using the method of "adjusted indirect comparisons." Patient demographics and disease characteristics were similar across studies, as were the response rates of patients receiving placebo, suggesting the validity of comparison between trials.
There were no statistically significant differences between treatments; yet responses ranged from 20 to 30% for ACR20 response, 3 to 10% for ACR50 response and 0 to 3% for ACR70 response.
The adjusted relative risk of ACR20 or ACR50 response did not differ significantly between treatments. The relative risk of ACR50 response with etanercept was 2.6 versus adalimumab and 1.92 versus infliximab; however, the 95% confidence intervals were wide and included unity.
Dr. Hochberg concludes from this study that "the 3 currently marketed TNFalpha blocking agents have similar efficacy when added to methotrexate in the treatment of patients with rheumatoid arthritis with active disease."
Ann Rheum Dis 2003 Nov;62 Suppl 2:II13-II16.
"Comparison of the efficacy of the tumour necrosis factor alpha blocking agents adalimumab, etanercept, and infliximab when added to methotrexate in patients with active rheumatoid arthritis"
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