Etanercept is effective as monotherapy or in combination with methotrexate in rheumatoid arthritis: subanalysis of an observational study.

Abstract

Approximately 30% of patients with rheumatoid arthritis receiving biological disease-modifying antirheumatic drugs (bDMARDs) take them as monotherapy. Although etanercept (ETN) monotherapy has been evaluated in clinical trials, data in the real-world setting are sparse. We compared the efficacy and safety of ETN, given alone or in combination with methotrexate (MTX), in routine clinical practice. This was a subanalysis of patients who received either ETN alone or ETN+MTX during a 52-week prospective, observational study conducted at 329 German centers. The primary endpoint was "Funktionsfragebogen Hannover" (Hannover Functional Ability Questionnaire [FFbH]; low FFbH=worse function) functional remission at week 26 and week 52. Secondary endpoints included the 28-joint count Disease Activity Score (DAS28), DAS28 remission (DAS28<2.6), and adverse events (AEs). Participating centers applied ETN monotherapy in 43.1% of patients and ETN+MTX in 56.9%. A smaller proportion of patients achieved FFbH functional remission with ETN vs ETN+MTX (31.9%, 95% confidence interval [CI] 29.1-34.9% vs 39.8%, 37.2-42.5%, respectively; p<0.001) at 26weeks and at 52weeks (38.4%, 35.1-41.7% vs 44.3%, 41.5-47.2%, respectively; p=0.007). After 52weeks, the mean DAS28 (±SD) decreased from 5.5±1.3 to 3.4±1.4 (ETN) vs 5.3±1.3 to 3.2±1.3 (ETN+MTX) and DAS28 remission was achieved by 32.5% (95% CI 29.0-36.1%) of patients with ETN vs 38.8% (35.8-41.9%; p=0.007) with ETN+MTX. Overall, 20.6 (ETN) and 19.7% (ETN+MTX) of patients reported treatment-related AEs. Patients received ETN monotherapy almost as often as ETN+MTX. ETN+MTX appeared marginally more effective than ETN monotherapy in some, but not all, outcomes measured.