RESEARCH - Response to Remicade or Enbrel as monotherapy compared with cotherapy with MTX or another DMARD

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Arthritis Rheum. 2006 Jun;54(6):1786-94.

Comparison of the response to infliximab or etanercept monotherapy with the

response to cotherapy with methotrexate or another disease-modifying

antirheumatic drug in patients with rheumatoid arthritis: Results from the

British Society for Rheumatology Biologics Register.

Hyrich KL, Symmons DP, KD, Silman AJ.

University of Manchester, Manchester, UK.

OBJECTIVE: To compare outcome at 6 months in unselected " real-world "

patients with rheumatoid arthritis treated with etanercept or infliximab as

either monotherapy, cotherapy with methotrexate (MTX), or cotherapy with

another disease-modifying antirheumatic drug (DMARD). METHODS: A total of

2,711 subjects starting treatment with their first biologic agent (1,453

infliximab and 1,258 etanercept) were followed up for 6 months. Outcome was

assessed using the European League Against Rheumatism (EULAR) response

criteria. Ordinal regression was used to model the response in the MTX and

other DMARD cotherapy groups relative to the monotherapy group separately

for the 2 anti-tumor necrosis factor alpha agents, after adjusting for

baseline differences. RESULTS: Etanercept-treated patients had an increased

likelihood of achieving a higher EULAR response category with cotherapy with

MTX (odds ratio [OR] 2.0, 95% confidence interval [95% CI] 1.5-2.7) and with

another DMARD (OR 1.2, 95% CI 0.9-1.6) as compared with monotherapy. For

infliximab-treated patients, the likelihoods were 1.4 (95% CI 0.9-2.0) for

MTX and 1.3 (95% CI 0.8-2.1) for other DMARDs versus monotherapy. Cotherapy

with MTX or another DMARD produced significantly higher rates of remission

with etanercept (12% and 11%, respectively) as compared with etanercept

monotherapy (5%). Infliximab-treated patients showed similar remission rates

in the MTX and other DMARD cotherapy groups (8% and 5%, respectively) as in

the monotherapy group (7%).

CONCLUSION: In this study of real-world patients, the use of MTX and, to a

lesser extent, other DMARDs as cotherapy with etanercept was associated with

a higher likelihood of response. Although the infliximab guidelines suggest

that MTX be used as cotherapy, in clinical practice, both monotherapy and

cotherapy with DMARDs other than MTX are used. These data suggest that

either of the latter strategies may be useful in patients who are intolerant

to MTX.

PMID: 16736520

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6736520

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