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New study compares long-term benefits from etanercept and adalimumab for rheumatoid arthritis

Robin Wulffson MD's picture
rheumatoid arthritis, etanercept , Enbrel, adalimumab, Humira, treatment

A new study published by researchers in The Netherlands compared the long-term benefits from etanercept (Enbrel) and adalimumab (Humira) for rheumatoid arthritis. They published their findings in the December issue of the journal Arthritis & Rheumatism.

The researchers designed a study to compare the rates of sustained low and minimal disease activity and remission according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria during three-year follow-up in rheumatoid arthritis patients treated with etanercept and adalimumab in routine care. Both medications are in a class known as biologic response modifiers, or biologics. By working on the immune system, biologics block proteins that contribute to the disease process. They act by reducing the levels of tumor necrosis factor (TNF) in the body. This substance is produced by the body’s immune system. Individuals who suffer from rheumatoid arthritis produce too much TNF. Because they suppress the immune system, patients are at a greater risk for getting serious infections when taking them.

The study group comprised 407 rheumatoid arthritis patients previously unexposed to tumor necrosis factor antagonists were treated with etanercept (203 patients) or adalimumab (204 patients). They were assessed at three- and later six-month intervals. Treatment allocation was at the discretion of the treating rheumatologist. Clinical parameters were measured at each time point, as were anti-adalimumab antibodies in adalimumab-treated patients. Achievement of a good clinical outcome was defined as the occurrence of sustained (at least 12 consecutive months) low disease activity (28-joint Disease Activity Score [DAS28] less than 3.2), minimal disease activity (DAS28 less than 2.6), or ACR/EULAR remission based on the Simplified Disease Activity Index (SDAI).

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The researchers found that among the adalimumab group, 13% reached sustained low disease activity but not sustained minimal disease activity, 15% reached sustained minimal disease activity but not sustained remission according to the SDAI, and 16% reached sustained ACR/EULAR remission. Among the etanercept group, the corresponding rates were 16%, 11%, and 12%, respectively. Adalimumab-treated patients without anti-adalimumab antibodies (150 patients; 74%) had the best outcomes, and adalimumab-treated patients with anti-adalimumab antibodies had the worst; outcomes in etanercept-treated patients experienced an outcome between those of the adalimumab-treated patients. The differences were most apparent in the sustained SDAI remission and sustained minimal disease activity categories. For example, 40% of anti-adalimumab antibody–negative patients, 23% of etanercept-treated patients, and 4% of anti-adalimumab antibody–positive patients achieved at least sustained minimal disease activity.

The authors concluded that, overall, etanercept and adalimumab treatment appeared to be comparable in inducing a good long-term clinical outcome. However, in the case of adalimumab this outcome was strongly dependent on the presence or absence of anti-adalimumab antibodies.

Reference: Arthritis & Rheumatism

See also:
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Tofacitinib monotherapy reported to benefit rheumatoid arthritis patients
New study compares two drugs combined with methotrexate for rheumatoid arthritis treatment
Xeljanz may help rheumatoid sufferers not helped by methotrexate