The efficacy of switching from Enbrel to Remicade in patients with RA

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J Rheumatol. 2004 Jun;31(6):1098-102.

The efficacy of switching from etanercept to infliximab in patients with

rheumatoid arthritis.

Hansen KE, Hildebrand JP, Genovese MC, Cush JJ, Patel S, Cooley DA,

Cohen SB, Gangnon RE, Schiff MH.

Division of Rheumatology, University of Wisconsin, Madison, Wisconsin,

USA.

OBJECTIVE: To describe the degree of clinical benefit in patients with

rheumatoid arthritis (RA) who receive infliximab therapy after lack of

efficacy with etanercept. METHODS: In a retrospective study among 6

centers primarily designed to assess the safety of infliximab in

combination with leflunomide, a standardized chart review form was used

to collect data on 93 patients with RA. During that study, it was noted

that some of these patients had switched from etanercept to infliximab.

In this study, we compared the response of subjects switching from

etanercept to infliximab (n = 20) to that of subjects receiving

infliximab with no prior tumor necrosis factor (TNF) therapy (n = 73).

RESULTS: The swollen and tender joint count, patient and physician

global assessments, morning stiffness, and C-reactive protein all

improved substantially in both groups, with no statistical difference in

the degree of benefit between the groups. At the time of chart review,

switchers had received a statistically higher dose of infliximab than

controls (4.4 vs 3.19 mg/kg; p = 0.006) with a total of 5.7 and 5

infusions, respectively.

CONCLUSION: In this retrospective study, previous lack of efficacy with

etanercept did not predict lack of efficacy with infliximab. Indeed, the

degree of clinical improvement was similar in both groups, although

switchers were receiving a higher dose of infliximab at the time of

chart review. Our findings suggest that clinical response may differ

between anti-TNF agents, and lack of response to one agent may not

predict a lack of response to another.

PMID: 15170921

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Mayo Clinic in Rochester

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s Hopkins Medicine

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