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Similar Efficacy for Three Key Tumour Necrosis Factor Blocking Agents in Rheumatoid Arthritis: Presented at ACR

By Jerry Ingram

ORLANDO, FL -- October 28, 2003 -- Three tumour necrosis factor (TNF) blocking agents (adalimumab, etanercept and infliximab) appear to have comparable therapeutic benefit for the treatment of rheumatoid arthritis when used in combination with methotrexate and as a class may be superior in efficacy to the interleukin-1 (IL-1) blocker anakinra, researchers said.

"We found that all three TNF inhibitors are basically equally as effective when used mostly in combination with methotrexate [for the treatment of rheumatoid arthritis]. When you compare each of them to anakinra, adalimumab is statistically more effective than anakinra," said Melissa Hawkins-Holt, MD, lead researcher, from the University of Maryland School of Medicine, Baltimore, Maryland, United States.

Researchers presented the findings here on October 26^th at the Annual Meeting of the American College of Rheumatology (ACR).

Dr. Hawkins-Holt and colleagues conducted adjusted indirect comparisons in an attempt to develop an unbiased estimate of the comparative treatment effect of the different medications. They assessed the relative efficacy of the TNF blocking agents and IL-1 receptor antagonist when given in combination with methotrexate and as monotherapy.

The proportion of patients who achieved ACR 20, 50 and 70 responses in the placebo and active treatment groups were abstracted from the 6-month randomised placebo-controlled trials published in peer-reviewed journals or in Briefing Documents filed with the United States Food and Drug Administration (FDA). Relative risks (RR) and 95% confidence intervals (CI) for achieving ACR 20, 50 and 70 responses were calculated for each specific comparison.

There were no significant differences in efficacy among the three TNF blocking agents when they were used in combination with methotrexate. In addition, all three of the agents were more effective than the IL-2 blocker anakinra, taken at a dose of 100 mg daily. When used as monotherapy, etanercept at a dose of 25 mg twice weekly had a slight edge over adalimumab at a dose of 40 mg taken every other week. Both these drugs were more effectives than anakinra taken at 150 mg daily.

"This shows that they're all effective," said Dr. Hawkins-Holt. "So the choice doesn't necessarily have to be related to efficacy but in terms of what's practical for the patient. It mostly comes down to what the patient wants in terms of method of treatment and what their insurance covers."


[Study title: Comparing the Efficacy of Biologic Agents in the Treatment of Rheumatoid Arthritis. Abstract 235]

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