Etanercept in rheumatoid arthritis patients with a poor therapeutic response to infliximab

Knowing the efficacy of tumor necrosis factor alpha (TNF-alpha) antagonists infliximab or etanercept in patients with rheumatoid arthritis (RA), when one of these agents has failed, has important clinical implications. The aim of this study was to evaluate the efficacy and safety of etanercept in patients with RA, who had previously failed to infliximab. All patients with RA of our center, who were previously treated with infliximab and then switched to etanercept for at least 6 months were included. Several clinical and biological parameters of inflammatory activity along with the disease activity index DAS-28 were assessed at baseline, after 6 weeks, at the last infusion of infliximab and after 0, 3 and 6 months on etanercept. EULAR criteria of response to therapy were used. Fourteen RA patients (13 females) who fulfilled the inclusion criteria were selected. These patients had been treated with infliximab for a mean (SD) of 14.6 (8.3) months when this drug was stopped. Drug withdrawal owed to inefficacy in 12 patients and to adverse events in 2 patients. Most patients achieved a satisfactory clinical response within the first months of infliximab, with a subsequent loss of the therapeutic effects in spite of an increase in the infliximab dose or a reduction of the interval between infusions. In the group of 12 patients switched to etanercept because of infliximab inefficacy, a therapeutic response was achieved in 10 (83%) of them after 6 months of etanercept therapy. The DAS-28 score (SD) improved from 5.6 (1) to 4.3 (0.8) (p = 0.019). An even better therapeutic response to etanercept was observed in those patients with an initial poor response to infliximab. No serious adverse effects were recorded during etanercept treatment. Etanercept is an efficient and safe therapy in RA patients when infliximab treatment has failed.