Sustained etanercept with methotrexate is effective for achieving low disease activity in moderate rheumatoid arthritis patients

Jan 27th – Rheumatoid arthritis patients achieving a response while on methotrexate and etanercept experience relapse of increased disease activity upon withdrawal of etanercept.

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1. Rheumatoid arthritis patients achieving a response while on methotrexate and etanercept experience relapse of increased disease activity upon withdrawal of etanercept.

2. A half dose of etanercept may be as effective as standard dosing after initial therapy.

The PRESERVE study concluded that rheumatoid arthritis (RA) patients who responded to and continued etanercept with methotrexate treatment experienced lower levels of disease activity than those who withdrew etanercept at an earlier time. Patients in the etanercept groups were more likely to have low disease activity and fared better in radiological and subjective assessments than did the placebo group. The conclusions of this study are salient given that patients with moderate RA disease are clinically the most common patient subgroup.

While the benefit of sustained etanercept over placebo in achieving low disease state of RA is apparent in this well designed randomized controlled trial, there are still cost-effectiveness questions particularly in regards to dosing. The study was not designed to determine the most effective dosing regimen of etanercept, and future research should investigate this. Nonetheless, this well designed study indicates a benefit of using etanercept with methotrexate in patients with moderate RA in order to obtain sustained periods of low disease activity.

Click to read the study in Lancet

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Image: CC/Fdardel

1. Rheumatoid arthritis patients achieving a response while on methotrexate and etanercept experience relapse of increased disease activity upon withdrawal of etanercept.

2. A half dose of etanercept may be as effective as standard dosing after initial therapy.

This [randomized controlled] study: The study included a wide age-range of RA patients with moderately active disease while on methotrexate with a total enrollment of 807 patients. In the first phase of the trial, all patients were given etanercept plus methotrexate every week. Responders to therapy were randomized in a second phase to one of three groups: etanercept plus methotrexate, low dose etanercept plus methotrexate, or placebo plus methotrexate.

The primary outcome was the level of low disease activity (by the DAS28 score). Patients who remained on etanercept had a higher proportion of low-disease activity than those in the placebo group (82.6% vs 42.6%, p<.001). Of note, the radiographic progression of disease was also reduced in the etanercept groups.

Further reading:

1.     The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis.

2.     Disease outcome and functional capacity in rheumatoid arthritis (UpToDate).

3.     Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2011.

In sum: The PRESERVE study concluded that rheumatoid arthritis (RA) patients who responded to and continued etanercept with methotrexate treatment experienced lower levels of disease activity than those who withdrew etanercept at an earlier time. Patients in the etanercept groups were more likely to have low disease activity and fared better in radiological and subjective assessments than did the placebo group. The conclusions of this study are salient given that patients with moderate RA disease are clinically the most common patient subgroup.

While the benefit of sustained etanercept over placebo in achieving low disease state of RA is apparent in this well designed randomized controlled trial, there are still cost-effectiveness questions particularly in regards to dosing. The study was not designed to determine the most effective dosing regimen of etanercept, and future research should investigate this. Nonetheless, this well designed study indicates a benefit of using etanercept with methotrexate in patients with moderate RA in order to obtain sustained periods of low disease activity.

Click to read the study in Lancet

By [MCH] and [RR]

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hoaglinMike Hoaglin: Mike is a 4th year M.D. Candidate at the University of Pennsylvania.

 

 

 

 

Rif Rahman: Rif is a 4th year M.D. candidate at Harvard Medical School.

 

 

 

 

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