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Failure to Respond to etanercept does not Predict Response to Infliximab and Vice Versa

Patients with rheumatoid arthritis (RA) who fail treatment with etanercept may be treated successfully with infliximab and vice versa, reports a study from Boston.

Although both etanercept and infliximab, 2 new tumour necrosis factor (TNF)-alpha antagonists, are used to treat RA, the different molecular approach used by each to neutralize TNF-alpha raises the question about whether this difference translates into different clinical outcomes.

Herbert T.S. Ang, MD, MPH, Massachusetts General Hospital, United States, and colleagues retrospectively reviewed 29 patients with RA treated with both etanercept and infliximab to determine the correlation between clinical response (joint counts, acute phase reactants) and complications (infection, hypersensitivity, cytopaenia). In 24 patients, etanercept was the first TNF-alpha antagonist used before changing to infliximab in 12 patients because of inadequate response, 10 patients because of toxicity, and 2 patients for other reasons. In the 5 patients who first received infliximab and then changed to etanercept, 3 changed because of toxicity and 2 because of inadequate response.

No correlation was found between clinical response and use of either agent as indicated by the lack of statistical association between joint count responses (P = .70) and acute phase reactant response (P = .14) to either agent. Similarly, drug hypersensitivity reactions and infectious complications were not significantly correlated with either agent (P = .20 and P = 1.00, respectively). Patients who developed anaemia on one of the agents, however, were significantly more likely to develop it while using the other agent (P = .007).

These data suggest that no correlation exists between the clinical responses or development of complications when both agents were used in the same patient. Based on this, the authors conclude that "the failure to respond to one agent does not preclude the use of the other...and that the development of non life-threatening infections or hypersensitivity reactions with one agent is not a contraindication to using the second agent."
J Rheumatol. 2003 Nov;30:11:2315-2318. "Do the Clinical Responses and Complications Following Etanercept or Infliximab Therapy Predict Similar Outcomes with the Other Tumor Necrosis Factor-alpha Antagonists in Patients with Rheumatoid Arthritis?"

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