Abstract
Tumor necrosis factor (TNF) antagonists have dramatically improved the outcomes of rheumatoid arthritis (RA). Three agents currently available in the USA – infliximab, etanercept, and adalimumab – have been designed to modify the biologic effects of TNF. Infliximab and adalimumab are monoclonal antibodies, and etanercept is a soluble protein. The pharmacokinetic and pharmacodynamic properties of each differs significantly from those of the others. All three agents are effective and safe, and can improve the quality of life in patients with RA. Although no direct comparisons are available, clinical trials provide evidence that can be used to evaluate the comparative efficacy of these agents. Infliximab, in combination with methotrexate, has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, prevent joint erosions and joint-space narrowing, and improve physical function for up to 2 years. Etanercept has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, and slow the rate of joint destruction, and might improve physical function. Etanercept is approved with and without methotrexate for patients who have demonstrated an incomplete response to therapy with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs), as well as for first-line therapy in early RA, psoriatic arthritis, and juvenile RA. Adalimumab relieves the signs and symptoms of RA with and without methotrexate and other DMARDs, decreases total joint score progression, prevents joint erosions and joint-space narrowing in combination with methotrexate, and might improve physical function. When selecting a TNF antagonist, rheumatologists should weigh evidence and experience with specific agents before a decision is made for use in therapy.
Highlights
Rheumatoid arthritis (RA), a systemic disease, is the most common form of inflammatory arthritis [1]
Results at 2 years showed that mean HAQ scores declined Adalimumab plus methotrexate has been shown to be effiin both the early rheumatoid arthritis (RA) and late RA groups
The study concluded that aggressive double-blind, placebo-controlled, dose-ranging trial in therapy has a greater potential to improve disability, as which 271 patients with RA were administered adalimeasured by HAQ, in patients with early RA than in mumab 20, 40, or 80 mg s.c. every 2 weeks plus S7
Summary
Rheumatoid arthritis (RA), a systemic disease, is the most common form of inflammatory arthritis [1]. Two-year follow-up data from the ATTRACT study showed that infliximab inhibits structural damage in RA patients with moderately-to-severely active disease as assessed by the Sharp score, bone erosion scores, and joint-space narrowing scores [39,40,41]. In ATTRACT, all regimens (doses/schedules) of infliximab plus methotrexate showed significantly greater improvement from baseline in HAQ and the Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary score averaged over time through week 54 compared with placebo plus methotrexate [37,40]. The three members of this class – infliximab, mean change in total Sharp score of 7 units [40] This etanercept, and adalimumab – have shown efficacy in finding is consistent with that of other studies of structural inhibiting joint destruction over various lengths of time, joint damage in patients receiving DMARDs. reducing symptoms, and improving physical function in S9. Careful consideration of all these clinical variables and appropriate use of the newer additions to the antirheumatic armamentarium such as the TNF biologic response modifiers will, it is hoped, contribute to better outcomes for patients with RA
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