Patients with active rheumatoid arthritis (RA) are as likely to persist with adalimumab treatment as they are with etanercept, show the results of a 2-year randomized efficacy and discontinuation study of the two tumor necrosis factor (TNF) inhibitors.
"The choice of first TNF inhibitor is an important milestone in the treatment pathway of a patient with RA," contend Paresh Jobanputra (University of Birmingham, UK) and co-investigators.
The findings indicate that clinicians needing to choose between the two study drugs "may choose either agent in the knowledge that continuation or persistence with therapy after 2 years is likely to be similar," they add.
With a primary outcome of continued medication adherence after 52 weeks, the study included 120 RA patients aged over 18 years, who had had no response to at least two disease-modifying drugs including methotrexate, and who had a median disease duration of 6 years.
Participants were randomly assigned to receive either subcutaneous adalimumab 40 mg on alternate weeks (n=60), or etanercept 50 mg weekly via the same route (n=60).
At 1 year after medication initiation, 65.0% and 56.7% of patients were still taking adalimumab and etanercept, respectively, indicating no significant differences in adherence rate, report Jobanputra et al in BMJ Open.
Furthermore, the proportion of good, moderate, and nonresponders (according to the disease activity score using 28 joints and based on C-reactive protein levels) at the 1-year follow up did not differ significantly according to treatment group, at 26.3%, 33.3%, and 40.4%, respectively, for adalimumab, and 16.7%, 31.7%, and 51.7%, respectively, for etanercept.
By the 2-year follow-up point, a respective 58.3% and 43.3% of adalimumab and etanercept patients remained adherent to their treatment regimen.
Of the 14 serious adverse events that occurred in 13 patients, just three were thought to be related to the study drug. One patient on etanercept developed heart failure 2 weeks after drug withdrawal, while another was hospitalized with chest symptoms, and one patient on adalimumab developed acute cholecystitis.
"Drug cessation, or continued use, are key indicators of successful therapy in chronic disease, especially where the prospect of drug free remission is low and drug costs are high," conclude Jobanputra and colleagues.
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