Switching TNF Inhibitors May Improve Efficacy in Rheumatoid Arthritis

June 26, 2004

NEW YORK (Reuters Health) Jun 24 - Switching to infliximab after a poor

response with etanercept can improve outcomes for rheumatoid arthritis

patients, according to the results of a small study reported in the June

issue of The Journal of Rheumatology.

" I do not want people to infer that infliximab is therapeutically superior

to etanercept, but that switching tumor necrosis factor (TNF) inhibitors can

offer better disease control when the first drug does not fully control

symptoms and signs of rheumatoid arthritis, " lead author Dr. E. Hansen

from Veterans Hospital, Madison, Wisconsin told Reuters Health.

Dr. Hansen and colleagues compared the responses of 20 rheumatoid arthritis

patients switching from etanercept to infliximab with those of 73 patients

receiving infliximab with no prior TNF therapy.

Patients switching to infliximab had received slightly more doses on average

(5.7 infusions) than nave infliximab patients (5 infusions), the report

indicates, and switchers had received a significantly higher number of

previous disease-modifying antirheumatic drugs (DMARD).

Both groups experienced clinically significant improvements in disease

measures (including tender and swollen joint counts, patient and physician

global assessment, C-reactive protein, and morning stiffness), the authors

report, with no statistically significant difference between the groups.

Only 4 of 479 infusions were associated with infusion reactions, the results

indicate, and these occurred only in the nave patient group.

Infection rates, hospital admissions, and infusion reactions did not differ

between switchers and controls, the researchers note.

A patient with incomplete response to one anti-TNF agent, may achieve better

disease control with another TNF inhibitor, Dr. Hansen said. " If a patient

has not responded well to one TNF inhibitor, then try another. "

" Much remains to be learned about the exact mechanism of action of this

class of drugs, " writes Dr. Boulos Haraoui from Hopital Notre-Dame du CHUM,

Montreal, Quebec, Canada in a related editorial. " Such knowledge will help

us use anti-TNF agents in a more efficient manner. Until predictors of

response have been identified, use of these agents will be governed by

clinical judgment and accumulated experience. "

J Rheumatol 2004;31:1021-1022,1098-1002,1021-1022.

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