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Treatment with infliximab (Remicade) when etanercept (Enbrel) has failed or vice versa: data from the STURE registry showing that switching tumour necrosis factor α blockers can make sense
  1. R van Vollenhoven,
  2. A Harju,
  3. S Brannemark,
  4. L Klareskog
  1. Department of Rheumatology, Karolinska Hospital, 17176 Stockholm, Sweden
  1. Correspondence to:
    Associate Professor R F van Vollenhoven
    Department of Rheumatology, Karolinska Hospital, D2-1, 17176 Stockholm, Sweden;


Objective: When one TNFα blocker (etanercept or infliximab) has failed, to determine whether it makes sense to treat patients with the other.

Patients and methods: Since 1999 patients treated with etanercept or infliximab have been systematically followed up at our institution in the STURE database. We identified 31 patients who had received both agents.

Results: Eighteen patients received etanercept first; discontinuation was mostly due to lack of efficacy. DAS28 values had improved only slightly with etanercept, with a mean (SEM) best DAS28 value of 4.8 (0.6). After switching to infliximab, the mean best DAS28 was 3.6 (0.6)—significantly better than the previous result (p<0.05). Similarly, the mean best ACR-N during etanercept treatment was 17.2 (6.65) and during subsequent infliximab treatment 40.4 (10.6) (p = 0.08). Thirteen patients received infliximab first; discontinuation was mainly due to adverse events. The best DAS28 value achieved during etanercept was 3.6 (0.4) compared with 4.1 (0.4) for infliximab (p<0.05), but the change in DAS28 was not different and ACR-N were similar for infliximab and etanercept in this group.

Conclusion: For patients with insufficient efficacy from etanercept, treatment with infliximab provided better results, suggesting that a trial of infliximab is reasonable for such patients. For patients who discontinued infliximab owing to adverse events, treatment with etanercept gave at least similar clinical efficacy. Taken together, these data provide support for a trial of the reciprocal TNFα blocker in patients when one such agent has failed.

  • Rheumatoid arthritis
  • etanercept
  • infliximab
  • registry
  • ACR, American College of Rheumatology
  • DAS, disease activity score
  • DMARD, disease modifying antirheumatic drug
  • MTX, methotrexate
  • RA, rheumatoid arthritis
  • SJC, swollen joint count
  • TNFα, tumour necrosis factor α

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