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Etanercept in combination with conventional disease-modifying antirheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis patients intolerant to methotrexate.

Abstract
Although etanercept (ETN) is effective when used in monotherapy for the treatment of rheumatoid arthritis (RA), ETN/methotrexate (MTX) combination therapy is more efficacious. However, some patients show MTX intolerance; these patients may develop adverse events (AEs) or have risk factors for AEs. There is limited published information regarding the efficacy of combination therapy involving ETN and disease-modifying antirheumatic drugs other than MTX. Therefore, we evaluated the effects of combination therapy with ETN and salazosulfapyridine (SASP) and/or bucillamine (Bc), a D: -penicillamine analogue, in MTX-intolerant RA patients. Indices of RA activity, including disease activity score in 28 joints (DAS28), were retrospectively analyzed over a 48-week period in 66 patients treated with ETN. Treatment efficacy was compared in the following 4 major treatment groups: ETN monotherapy, ETN + MTX, ETN + SASP, and ETN + SASP + Bc. Although intergroup differences in the percent change of DAS were not statistically significant, ETN + SASP + Bc seemed to be more effective than ETN monotherapy, and the efficacy of ETN + SASP + Bc was comparable to that of ETN + MTX according to the European League Against Rheumatism (EULAR) improvement ratings. These results suggest that ETN + SASP + Bc combination therapy may be a viable option for RA treatment in patients in whom MTX cannot be used.
AuthorsYoshinobu Koyama, Hirokazu Shiraishi, Toshiyuki Ohta, Ayumi Uchino
JournalModern rheumatology (Mod Rheumatol) Vol. 22 Issue 1 Pg. 100-8 (Feb 2012) ISSN: 1439-7609 [Electronic] England
PMID21706263 (Publication Type: Journal Article)
Chemical References
  • Antirheumatic Agents
  • Glucocorticoids
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Sulfasalazine
  • Cysteine
  • Etanercept
  • bucillamine
  • Methotrexate
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents (therapeutic use)
  • Arthritis, Rheumatoid (diagnosis, drug therapy, physiopathology)
  • Cysteine (analogs & derivatives, therapeutic use)
  • Drug Substitution
  • Drug Therapy, Combination
  • Etanercept
  • Female
  • Glucocorticoids (therapeutic use)
  • Humans
  • Immunoglobulin G (therapeutic use)
  • Joints (drug effects, physiopathology)
  • Male
  • Methotrexate (adverse effects)
  • Middle Aged
  • Pain Measurement
  • Receptors, Tumor Necrosis Factor (therapeutic use)
  • Recovery of Function
  • Retrospective Studies
  • Severity of Illness Index
  • Sulfasalazine (therapeutic use)
  • Treatment Failure

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