| Abstract | (1) There is no consensus on the best treatment option for rheumatoid arthritis when a first-line agent fails (most often methotrexate). Among the recent immunosuppressants, etanercept should be used before infliximab. (2) Anakinra, an interleukin-1 type 1 receptor antagonist, was recently authorised in the European Union as a second-line treatment for rheumatoid arthritis in combination with methotrexate. (3) There are no published trials comparing anakinra with other slow-acting antirheumatic drugs (especially infliximab and etanercept). In one clinical trial in patients who did not respond adequately to methotrexate, the combination anakinra + methotrexate was more effective than methotrexate + placebo on ACR 20%, ACR 50% and ACR 70% criteria, but the clinical relevance of these results is doubtful. (4) An indirect comparison suggests that etanercept is more effective than anakinra + methotrexate. (5) In a placebo-controlled trial of anakinra, 75% of patients had reactions at the injection site. Serious infections, neutropenia and anti-anakinra antibodies were also reported. There is no evidence that anakinra is any safer than etanercept. (6) Anakinra + etanercept offers no gains in efficacy, just an increased risk of severe infections. (7) Subcutaneous injections of anakinra are required daily (twice-weekly subcutaneous injections for etanercept). (8) In short, there is no argument for using anakinra as a second-line treatment for rheumatoid arthritis; it does not improve disease management. |
| Authors | |
| Journal | Prescrire international
(Prescrire Int)
Vol. 13
Issue 70
Pg. 43-5
(Apr 2004)
ISSN: 1167-7422 France |
| PMID | 15148945
(Publication Type: Comparative Study, Journal Article)
|
| Chemical References |
- Antirheumatic Agents
- Immunoglobulin G
- Immunosuppressive Agents
- Receptors, Interleukin-1
- Sialoglycoproteins
- Methotrexate
|
| Topics |
- Antirheumatic Agents
(therapeutic use)
- Arthritis, Rheumatoid
(drug therapy)
- Drug Therapy, Combination
- Humans
- Immunoglobulin G
(therapeutic use)
- Immunosuppressive Agents
(therapeutic use)
- Methotrexate
(therapeutic use)
- Receptors, Interleukin-1
(antagonists & inhibitors)
- Sialoglycoproteins
(administration & dosage, adverse effects, therapeutic use)
|
