BARI, Italy— Switching to etanercept (Enbrel®) can maintain the clinical benefits of infliximab (Remicade®) for  rheumatoid arthritis (RA) patients who have responded to infliximab but stopped the latter drug because of adverse effects, according to a new study published online in the Annals of the Rheumatic Diseases.¹ The new findings add to a growing body of literature on switching tumor necrosis factor (TNF) inhibitors to minimize adverse effects while maximizing and maintaining benefits.

"Our study shows that etanercept maintains the clinical benefit achieved by infliximab, and suggests that a second TNF inhibitor can be the favorable therapy for RA when a first TNF-α blocker has been withdrawn because of adverse events," concludes lead researcher Florenzo Iannone, MD, of the department of internal medicine and public medicine, rheumatology unit, University of Bari, Italy.1 "Further speculation rising from this study is that occurrence of side effects of a first TNF-α blocking agent does not predict adverse events to a different anti-TNF-α inhibitor, [and] taken together these data suggest that TNF-α targeting strategy can be the favorable therapy to follow in RA when a first TNF-α inhibitor has caused the appearance of adverse effects," Dr. Iannone adds.

Retrospective Study of Patients Who Switched

To examine the question of what happens after side effects mandate a switch from infliximab to etanercept, the researchers reviewed the charts of 553 patients with RA and found 37 who had responded to infliximab but switched to etanercept because of adverse effects (mainly infusion reactions). They compared clinical data for the first 24 weeks of etanercept therapy with data for 24 weeks of infliximab treatment before it was stopped. Outcome measures included Disease Activity Score (DAS)-44, erythrocyte sedimentation rate (ESR) first hour, visual analog scale, pain, health assessment questionnaire (HAQ), and C-reactive protein (CRP) every 8 weeks.

The improvements in DAS-44, HAQ, ESR, and CRP were maintained after the switch to etanercept, the study showed. Interestingly, viral arthritis syndrome pain decreased significantly after the change in therapy.

The authors note that previous studies of switching from one TNF inhibitor to another usually focused on patients who changed treatment because of lack of efficacy of the first TNF inhibitor. In this study, all patients had responded to infliximab, and the question being asked was whether this response was maintained after the change to etanercept.

"Etanercept was capable of maintaining the clinical benefit achieved by infliximab, and no significant differences in terms of biologic indices and clinical outcomes were detected between the best response to infliximab treatment, prior to withdrawal, and etanercept therapy," the researchers conclude.

Reference

1. Iannone F, Trotta  F, Montecucco C, et al. Etanercept maintains the clinical benefit achieved by infliximab in patients with rheumatoid arthritis who discontinued infliximab due to side effects. Ann Rheum Dis. 2006 July 12; [Epub ahead of print].