You are here

Article Text

Article menu

Download PDFPDF

Matters arising
Etanercept is effective in patients with rheumatoid arthritis with no response to infliximab therapy
Free
  1. J A Gómez-Puerta,
  2. R Sanmartí,
  3. J R Rodríguez-Cros,
  4. J D Cañete
  1. Arthritis Unit, Rheumatology Department, IDIBAPS, Hospital Clínic de Barcelona, Spain
  1. Correspondence to:
    Dr R Sanmartí
    Rheumatology Department, Hospital Clínic, Villarroel 170, Barcelona, Catalonia, Spain; sanmarticlinic.ub.es

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    We read the recent article by van Vollenhoven et al1 on the efficacy of one tumour necrosis factor α antagonist (infliximab or etanercept) when the other has failed with great interest. The authors concluded that infliximab is efficacious in a significant proportion of patients who have not responded to etanercept. No conclusive results were reported when they analysed the opposite situation, probably because 11 of the 13 patients who switched from infliximab to etanercept did so owing to adverse events rather than inefficacy.

    We recently studied 12 patients with rheumatoid arthritis (11 women) who were switched from infliximab to etanercept because of inefficacy.2 Infliximab was used for a mean (SD) of 15.6 (8.6) months (range 2–29). Most patients had a satisfactory clinical response to infliximab at the start of treatment with a later reduction in efficacy despite increased doses of infliximab and/or frequency of infusions. They were switched to etanercept and after 6 months of treatment, 10/12 (83%) patients had a good (2 patients) or moderate (8 patients) therapeutic response according to the EULAR criteria, in comparison with the response at the end of infliximab treatment. The Disease Activity Score, DAS28, improved from a mean (SD) of 5.63 (1.1) to 4.30 (0.8) (p = 0.019) and the percentage of patients with DAS28>5.1 was reduced from 75% at the end of infliximab treatment to 8% (p = 0.009). Figure 1 shows the DAS28 scores during treatment. Interestingly, the four patients who never achieved a response to infliximab, showed an impressive response to etanercept; similar results were recently reported by Buch et al.3 There were no serious adverse events with the etanercept treatment.

    Figure 1
    Figure 1

     Disease activity according to DAS28 in 12 patients with RA treated with infliximab and switched to etanercept. Mean DAS values are shown for infliximab (INF; baseline, 6 weeks of treatment, last infusion) and etanercept (ETC; baseline, 3 and 6 months of treatment). Comparison was made using a non-parametric test (Wilcoxon). m, months; w, weeks.

    Few reports are available on this subject.3–6 Based on available data and our results, we suggest that etanercept is effective in a significant proportion of patients with a poor or non-sustained response to infliximab.

    References

    1. ↵
      van Vollenhoven R , Harju A, Brannemark S, Klareskog L. 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. Ann Rheum Dis2003;62:1195–8.
      OpenUrlAbstract/FREE Full Text
    2. ↵
      Sanmarti R , Gómez-Puerta JA, Rodríguez-Cros JR, Albaladejo C, Muñoz-Gómez J, Cañete JD. Etanercept in rheumatoid arthritis patients with a poor therapeutic response to infliximab. Med Clin (Barc)2004;122:321–4.
      OpenUrlCrossRefPubMed
    3. ↵
      Buch MH, Bingham SJ, Bejarano V, White J, Emery P. Do patients with rheumatoid arthritis demonstrate an improvement on etanercept following an inadequate response to infliximab? [abstract]. Arthritis Rheum2003;48 (suppl) :S325.
    4. Brocq O , Plubel Y, Breuil V, Grisot C, Flory P, Mousnier A, et al. Etanercept-infliximab switch in rheumatoid arthritis 14 out of 131 patients treated with anti TNF alpha. Presse Med2002;31:1836–9.
    5. Herbert TS, Helfgott S. Do the clinical responses and complications following etanercept or infliximab therapy predict similar outcomes with the other tumor necrosis factor-α antagonist in patients with rheumatoid arthritis? J Rheumatol2003;30:2315–18.
      OpenUrlAbstract/FREE Full Text
    6. ↵
      Haraoui PB, Keystone EC, Thorne JC, Pope JE, Asare C, Leff J. The Canadian biologic observational switchover survey (BOSS): functional status of patients with rheumatoid arthritis after switching from infliximab to etanercept therapy [abstract]. Ann Rheum Dis2003;62 (suppl I) :S223.
      OpenUrl