Background Combination treatment of Etanercept with corticosteroids and/or Methotrexate has been shown to have an impact on the occurrence of adverse events. (1)
Methods The data base of the German BIKER registry documenting the treatment of juvenile idiopathic arthritis patients (JIA) with Etanercept since 2001 has been used to analyse the impact of treatment on the discontinuation of concomitant drug treatment, especially of corticosteroids, NSAIDs, Methotrexate and further DMARDs.
Results 1276 JIA patients have been identified with a baseline visit and at least 1 follow up visit. At baseline, 1039 (81.4%) received NSAIDs, 582 (44%) received corticosteroids (median dosage 5 mg/day) and 928 (72.7%) received Methotrexate. 233 (18.3%) received other DMARDs (Azathioprine (5.5), Cyclosporine A (2.3%), Leflunomide (2.3%), Sulfasalazin (4.2%), (OH)Chloroquine (2.1%) as further concomitant treatment. Upon treatment, concomitant pharmacomedical treatment was continuously reduced over time (table).
At 12 months 53% of patients received NSAIDs, and 58.9% Methotrexate, 29.3% corticosteroids. In total, 445/928 (48%) patients discontinued Methotrexate with a mean survival of combination with MTX of 34.5 months. 260/582 (45%) of patients discontinued corticosteroids with a mean survival of combination with corticosteroids of 26.5 months. So, corticosteroids have significantly earlier been discontinued than Methotrexate (p=0.006, Hazard ratio 1.2 (1.0-1.4). Of those 83 patients with uveitis as co morbidity, 35 (42%) discontinued MTX with a mean survival of MTX of 43 months.
Conclusions Upon treatment with Etanercept, most patients initially received concomitant treatment with NSAIDs, corticosteroids, Methotrexate, and other DMARDs. However these drugs are frequently discontinued, while corticosteroids were discontinued prior to Methotrexate.
Horneff G, De Bock F, Foeldvari I, et al: Safety and efficacy of combination of etanercept and methotrexate compared to treatment with etanercept only in patients with juvenile idiopathic arthritis (JIA): preliminary data from the German JIA Registry. Ann Rheum Dis. 2009 Apr;68(4):519-25.
Disclosure of Interest G. Horneff Grant/Research support from: Pfizer, Abbott, K. Minden: None Declared