Etanercept seems to be the TNF inhibitor of choice over time for people with rheumatoid arthritis (RA). In a large Swedish study lasting five years people were less likely to switch from etanercept than from infliximab or adalimumab. This doesn\u2019t mean that etanercept is more effective, it just means that some patients find it works better for them than the other options.<\/p>\n
INTRODUCTION <\/strong><\/p>\n Tumour necrosis factor (TNF) inhibitors, also known as biologics, are still fairly recent additions to the treatment options for RA. In the UK doctors generally only offer TNF inhibitors to people who don\u2019t do well on the more established disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate. However, their use is becoming more common and researchers are finding out more about them.<\/p>\n <\/p>\n WHAT DID THE RESEARCHERS HOPE TO FIND?<\/strong><\/p>\n The researchers were interested in studying what they call \u2018drug survival\u2019: how long someone uses a particular drug treatment before they decide it\u2019s either not doing them much good or it\u2019s causing unbearable side effects. The researchers in this study wanted to find out how three TNF inhibitors \u2013 etanercept, infliximab, and adalimumab \u2013 compared with each other in terms of how many people stuck with them and how many switched to another treatment.<\/p>\n WHO WAS STUDIED?<\/strong><\/p>\n The study covered more than 9,000 people in Sweden with RA. The researchers looked at the data for people who started treatment with TNF inhibitors in two time periods, the first between 2003 and 2005, and the second between 2006 and 2009. This gave the researchers the chance to see whether people\u2019s acceptance of the various drugs changed as the drugs became more established as treatment options.<\/p>\n HOW WAS THE STUDY CONDUCTED? <\/strong><\/p>\n The researchers used Swedish medical records (specifically a database called the Swedish Biologics Register) to look at people using TNF inhibitors for the first time. Over a five-year period (for each of the two groups) they then looked at how many people stopped using them and why.<\/p>\n WHAT DOES THE NEW STUDY SAY? <\/strong><\/p>\n About half the people in the study stopped treatment with their first TNF inhibitor at some point during the five-year study period. People were more likely to stop using their treatment because they felt it didn\u2019t work well enough than because it caused side effects. \u25b8 The drug with the highest rate of people stopping treatment was infliximab. HOW RELIABLE ARE THE FINDINGS?<\/strong><\/p>\n This study has a lot of strong points: it used reliable data, included a lot of people, had a long follow-up period and included the majority of biological treatments available for RA at the time. It was also what\u2019s called a \u2018real world\u2019 study using data from medical records and databases. This means that the people weren\u2019t enrolled in a drug trial so their decision-making was less prone to bias and arguably more natural than if they\u2019d known they were going to be part of a study.<\/p>\n WHAT DOES THIS MEAN FOR ME?<\/strong><\/p>\n Perhaps this study\u2019s most interesting finding is that people in the later study group were more likely to decide to change treatments than those in the earlier group, even though they rated the treatments higher than the earlier group had. The researchers say that this reflects higher expectations of treatment as time has gone on, and that people know that the number of available treatments for RA is increasing. The other thing to say is that, just because people in this study were most likely to stick with etanercept and least likely to keep using infliximab, that doesn\u2019t mean that etanercept is necessarily a \u2018better\u2019 treatment. For example, it\u2019s possible that some people didn\u2019t like infliximab because it is given by an infusion or \u2018drip\u2019, which takes longer than treatment with the other drugs, which are given by injection. This study\u2019s findings are interesting, but the most important thing is to find the treatment that works for you. And, finally, it might seem gloomy that half the people studied felt they needed to change from the first TNF inhibitor they tried. But let us put it another way. Half the people were happy with their first TNF inhibitor, and were still happy with it five years later. With a condition like RA where many people have to try several treatments before they find what works best, that\u2019s arguably not a bad average.<\/p>\n Disclaimer:<\/strong> This is a summary of a scientific article written by a medical professional (\u201cthe Original Article\u201d). The Summary is written to assist non medically trained readers to understand general points of the Original Article. \u00a0It should not be relied on in any way whatsoever<\/span>, (which also means the Summary is not medical advice), and is simply supplied to aid a lay understanding of general points of the Original Article. It is supplied \u201cas is\u201d without any warranty. You should note that the Original Article (and Summary) may not be accurate as errors can occur and also may be out of date as medical science is constantly changing. \u00a0It is very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care. Do not use this Summary as medical advice even if the Summary is supplied to the reader by a medical professional. Date summary prepared: February 2015<\/p>\n Summary based on research article published on: 27 November 2013<\/span><\/p>\n From: Neovius M, Arkema EV, Olsson H, et al<\/em>. Drug survival on TNF inhibitors in patients with rheumatoid arthritis comparison of adalimumab, etanercept and infliximab. Ann Rheum Dis<\/em> 2015;74:354\u201360. doi:10.1136\/annrheumdis-2014-201428<\/p>\n Copyright \u00a9 2015 BMJ Publishing Group Ltd & European League Against Rheumatism. Medical professionals may print copies for their and their patients and students non commercial use. Other individuals may print a single copy for their personal, non commercial use. For other uses please contact our Rights and Licensing<\/a> Team.<\/p>\n","protected":false},"excerpt":{"rendered":" Etanercept seems to be the TNF inhibitor of choice over time for people with rheumatoid arthritis (RA). In a large Swedish study lasting five years people were less likely to switch from etanercept than from infliximab or adalimumab. This doesn\u2019t mean that etanercept is more effective, it just means that some patients find it works […]<\/p>\n
\n\u25b8 The drug with the lowest rate of people stopping treatment was etanercept.
\n\u25b8 People were more likely to stop taking adalimumab than etanercept, but only in the first year of treatment. The researchers aren\u2019t sure why this was.
\n\u25b8 More people in the later study group (those who started treatment between 2006 and 2009) stopped treatment with TNF inhibitors, even though people in this group judged that the drugs worked better and caused fewer side effects.<\/p>\n
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