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Etanercept maintains the clinical benefit achieved by infliximab in patients with rheumatoid arthritis who discontinued infliximab because of side effects
  1. Florenzo Iannone1,
  2. Francesco Trotta2,
  3. Carlomaurizio Monteccuco3,
  4. Roberto Giacomelli4,
  5. Mauro Galeazzi5,
  6. Marco Matucci-Cerinic6,
  7. Clodoveo Ferri7,
  8. Maurizio Cutolo8,
  9. Lisa Maria Bambara9,
  10. Giovanni Triolo10,
  11. Gianfranco Ferraccioli11,
  12. Gabriele Valentini12,
  13. Giovanni Lapadula1,
  14. on behalf of GISEA (Gruppo Italiano per lo Studio delle Early Arthritis)
  1. 1Department of Internal Medicine and Public Medicine, Rheumatology Unit, University of Bari, Bari, Italy
  2. 2Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Ferrara, Ferrara, Italy
  3. 3Chair and Division of Rheumatology, University of Pavia IRCCS Policlinico S Matteo, Pavia, Italy
  4. 4Department of Internal Medicine and Public Health, University of L’Aquila, L’Aquila, Italy
  5. 5Institute of Rheumatology, University of Siena, Siena, Italy
  6. 6SOD Internal Medicine I and Rheumatology, AOUC Careggi, University of Florence, Florence, Italy
  7. 7Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
  8. 8Research Laboratory and Division of Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  9. 9Department of Experimental and Clinical Medicine, University of Verona, Verona, Italy
  10. 10Rheumatology Unit, University of Palermo, Palermo, Italy
  11. 11Division of Rheumatology, Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, Rome, Italy
  12. 12Rheumatology Unit, Second University of Naples, Naples, Italy
  1. Correspondence to:
    Giovanni Lapadula
    DIMIMP-Sezione di Reumatologia, Policlinico, Piazza G Cesare 11, 70124 Bari, Italy;g.lapadula{at}


Objective: To evaluate the efficacy of switching to etanercept treatment in patients with rheumatoid arthritis who already responded to infliximab, but presented side effects.

Methods: Charts of 553 patients with rheumatoid arthritis were retrospectively reviewed to select patients who responded to the treatment with infliximab and switched to etanercept because of occurrence of adverse effects. Clinical data were gathered during 24 weeks of etanercept treatment and for the same period of infliximab treatment before infliximab was stopped. Disease Activity Score computed on 44 joints (DAS-44), erythrocyte sedimentation rate (ESR) 1st hour, Visual Analogue Scale (VAS) of pain, Health Assessment Questionnaire (HAQ), and C reactive protein (CRP) were assessed every 8 weeks.

Results: 37 patients were analysed. Adverse events to infliximab were mostly infusion reactions. No statistically significant difference between infliximab, before withdrawal, and etanercept, after 24 weeks, was detected in terms of DAS-44 (2.7 and 1.9, respectively), HAQ (0.75 and 0.75, respectively), ESR (21 and 14, respectively) and CRP (0.5 and 0.3, respectively). VAS pain decreased significantly after switching to etanercept treatment (40 and 24, respectively; p<0.05).

Conclusions: Our study shows that etanercept maintains the clinical benefit achieved by infliximab, and suggests that a second tumour necrosis factor (TNF) α inhibitor can be the favourable treatment for rheumatoid arthritis when the first TNFα blocker has been withdrawn because of adverse events.

  • ACR, American College of Rheumatology
  • CRP, C reactive protein
  • DAS-44, Disease Activity Score computed on 44 joints
  • ESR, erythrocyte sedimentation rate
  • EULAR, European League Against Rheumatism
  • HAQ, Health Assessment Questionnaire
  • RAI, Ritchie Articular Index
  • TNF, tumour necrosis factor
  • VAS, Visual Analogue Scale

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    BMJ Publishing Group Ltd and European League Against Rheumatism