Clinical impact of switching from infliximab to etanercept in patients with rheumatoid arthritis

Abstract

We assessed the disease activity in patients with rheumatoid arthritis (RA) after switching from infliximab to etanercept according to the reason of infliximab discontinuation. At Helsinki University Central Hospital during the period 1999 to 2003, 49 patients with RA were switched from infliximab to etanercept. The reasons for infliximab discontinuation were: 42% for failure to respond by >American College of Rheumatology 50% criteria; 12% for adverse events; 46% responded to infliximab and were switched for non-medical reasons. Clinical outcome after the switch was compared between the groups according to the reason of infliximab discontinuation. Disease activity was measured with the 28-joint count Disease Activity Score (DAS28). In patients in the non-medical reasons group, the disease activity was suppressed effectively both during infliximab and etanercept. Furthermore, the one-year drug survival of etanercept in this group was the highest of 77% (95% confidence interval (CI), 62 to 97) among the three groups. In patients in the infliximab failure and adverse event groups, DAS28 values improved significantly during etanercept therapy. The 1-year drug survival of etanercept was 43% (95% CI, 26 to 70) and 50% (95% CI, 33 to 100), respectively. For RA patients who discontinued taking infliximab because of non-medical reasons experienced similar treatment efficacy during both biological agents. The treatment with etanercept provided sufficient disease control also for patients with infliximab failure or adverse event. Therefore, etanercept can be suggested when infliximab has failed or discontinued for other reasons.

Estratégia de troca entre agentes anti-TNF-alfa não melhora a capacidade funcional em pacientes com artrite reumatoide de longa evolução

“…21 Similar fi ndings have also been reported by other authors. [22][23][24] Almost 20% of our patients switched from the soluble TNFalpha receptor to monoclonal antibodies. Regarding the switch from the soluble TNF-alpha receptor to monoclonal antibodies, Gomes-Reino et al, 11 assessing data from the Spanish registry, have reported that 52 patients on ETN switched to IFX, and 14 to ADA.…”

Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor: a systematic review and economic evaluation

“…Seven uncontrolled observational studies [98][99][100][101][102][103][104] were identified that assessed efficacy of ETN.…”

“…The patient population in this study was therefore different from the other studies. In Laas et al, 103 patients discontinued IFX owing to a lack of efficacy, safety or non-medical reasons. The group of patients who discontinued IFX owing to non-medical reasons (46%, 23/49) had responded well to IFX, but switched to ETN for practical reasons such as convenience (e.g.…”

“…Five were prospective 98,99,101,103,104 and two were retrospective. 100,102 Full details of the quality assessment are reported in Table 11.…”

“…Figure 11 presents the mean changes from baseline in DAS. Four studies 100,101,103,104 reported using DAS28. The mean decrease in DAS28 ranged from 1.47 to 1.80 at 3 months.…”