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Infliximab and Etanercept Can be Exchanged for Each Other if Initial Treatment Fails

Patients who fail etanercept or infliximab treatment may switch to the other tumour necrosis factor alpha (TNFalpha), providing them with a reasonable treatment option, reports a study from Sweden.

One way to optimise the use of antirheumatic agents is to switch to a different TNFalpha after initial failure on one of the agents. However, not all patients respond to the TNFalpha blockers and therefore switching may not be a practical clinical option.

To evaluate whether switching TNFalpha blockers is a reasonable clinical option for patients who fail one of the agents, R F van Vollenhoven, MD, and colleagues, Karolinska Hospital, Stockholm, retrospectively examined 31 patients treated with both etanercept and infliximab. Of these patients, 18 first received etanercept and then switched to infliximab. Fourteen switched because of lack of efficacy, 2 because of side effects, and 2 for unknown reasons.

Of the 13 patients treated first by infliximab and then switched to etanercept, 11 switched because of adverse events, 2 because of liver toxicity, 1 because of change in olfaction, and 2 for miscellaneous reasons. The dose for etanercept was 25 mg delivered subcutaneously 2 times a week, and the dose for infliximab was 3 mg/kg infused intravenously at 0, 2, and 6 weeks and every 8 weeks thereafter. Methotrexate was given to 11 of the 18 patients in the initial etanercept group and to all 13 patients in the initial infliximab treated group.

In patients who switched from etanercept to infliximab, disease activity, as measured by disease activity score (DAS)28, improved significantly from 5.2 just before starting infliximab to 3.6 after receiving infliximab (P < .02). Of particular importance, the best DAS28 score achieved during infliximab treatment was significantly better than the best DAS28 score achieved with etanercept (4.8 vs. 3.6, respectively; P < .05).

For patients who switched from infliximab to etanercept, the best DAS28 score obtained with etanercept was significantly decreased compared to infliximab (3.6 vs. 4.1, respectively; P < .05). The overall changed in DAS28, however, was not different after switching to etanercept.

The authors conclude that switching from etanercept to infliximab improved results and switching from infliximab to etanercept conferred similar clinical results. According to the authors, "these data provide support for a trial of the reciprocal TNFalpha blocker in patients when one such agent has failed."

Ann Rheum Dis 2003;62:12:1195-8. "Treatment with infliximab (Remicade) when etanercept (Enbrel) has failed or vice versa: data from the STURE registry showing that switching tumour necrosis factor alpha blockers can make sense"

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