Background Anti-tumor necrosis factor (TNF) therapy is recommended when conventional DMARDs therapy fails to decrease disease activity of rheumatoid arthritis (RA) to at least low disease activity. One of the advantages in anti-TNF therapy is its rapid response in comparison to conventional DMARDs therapy. Although several anti-TNF agents are available in clinical setting, the information on the difference in rapidness of early response among different anti-TNF agents is lacking.
Objectives The objectives of this retrospective study is to compare early clinical efficacy among three anti-TNF agents, namely infliximab (IFX), etanercept (ETN) and adalimumab (ADA), in RA patients. This study is called “Drag Race Study”.
Methods Bio-naive RA patients treated with one of three anti-TNF agents with concomitant MTX were included in this Drag Race Study. Clinical data at initiation and at 6 weeks in IFX-group (n=64) and clinical data at in initiation and at 4 weeks in ETN-group (n=43) and ADA-group (n=24) were used. IFX was infused in the dosage of 3mg/kg at 0w, 2w and 6w. ETN was subcutaneously injected in the dosage of 50mg/w or 25mg/w. ADA was subcutaneously injected at the dosage of 40mg per every other week. Improvement rate (%) and improvement value (Delta) of 6 indices (DAS28-ESR, DAS28-CRP, VAS, CRP, ESR, MMP-3, mHAQ) were compared between groups. Comparison between ETN25mg/w-group and ETN 50mg/w-group was also performed.
Results Mean age (years old) in IFX-G, ETN-G and ADA-G was 54, 58 and 58, respectively. Mean RA duration (years) in IFX-G, ETN-G and ADA-G was 9.8, 9.6 and 9.6, respectively. The baseline characteristics of patients and the baseline disease activity were comparable among there groups. Results were shown in the table. No significant difference was observed between groups. There was no significant difference in early clinical efficacy between ETN25mg/w-G and ETN50mg/w-G.
Conclusions This study showed that all of three anti-TNF agents had early excellent clinical efficacy in same extent and that early efficacy in ETN25mg/w-G was comparable to that in ETN50mg/w-G. This study suggests that rapid step-up in the treatment, for example dose escalation of biological agents or concomitant DMARDs, may be necessary when early effects of anti-TNF therapy are not excellent.
Disclosure of Interest None Declared
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