Tumour
necrosis factor (TNF) is an important inflammatory disease mediator in a wide spectrum of articular diseases, including adult and
juvenile rheumatoid arthritis (RA, JRA).
Etanercept (
Enbrel), approved in the United States and in Europe for use in patients with RA and JRA, is an effective inhibitor of TNF that has been shown to provide rapid and sustained improvement in both of these diseases. Long term studies continue to show that
etanercept controls signs and symptoms of RA and JRA with no change in rate or type of adverse event over time. To demonstrate that
etanercept is effective as first line treatment for patients with early active RA who have not been previously treated with
methotrexate, and to examine the effect of
etanercept on radiographic progression, a double blind, placebo controlled study was recently conducted, comparing
etanercept with
methotrexate (median dose 20 mg per week). Both
etanercept 25 mg twice weekly and rapidly escalated
methotrexate were effective in reducing the signs and symptoms of RA, and
etanercept was significantly better than
methotrexate in slowing the rate of radiographic erosions. In patients with severe
psoriatic arthritis (PsA), a double blind, placebo controlled study demonstrated that
etanercept was also effective in reducing disease activity in PsA.
Etanercept has been well tolerated in all of these clinical trials and offers an important new treatment option to patients with inflammatory articular diseases.