Effect of Etanercept, Infliximab and Methotrexate in the Treatment of Arthritis

Abstract

Background: Rheumatoid arthritis a chronic inflammatory autoimmune disease with inflammation of the joint, leading to damage of bone and surrounding cartilage.

Objectives: Our study was designed to find the efficacy of etanercept, infliximab and methotrexate in effective therapeutic management against arthritis patients.

Methods: A total of 315 patients, including both the sexes in the age group of 45–70 years with active rheumatoid arthritis attending Hospital of Academy of Military Medical Sciences, Beijing, China during the period of December 2012 to November 2013 were included in the study. 100 patients with joint pains, but not with rheumatoid arthritis were taken as a control group. All the patients were treated with infliximab, methotrexate and etanercept.

Results: In our study, patients responded, 75% to infliximab and etanercept combinations than to methotrexate. The combination therapy also showed a radiological decrease in the joint damage. There is significant when combinations of these drugs were used for the therapy (P<0.001).

Conclusion:In our study, use of infliximab and etanercept combinations lowered the joint damage and helped in the improvement of the patient’s life.

Key words

rheumatoid arthritis - therapy - joint damage - efficacy

• References

• 1 Lipsky PE. Rheumatoid arthritis. In: Fauci AS, Braunwald E, Isselbacher KJ. et al eds. Harrison’s principles of internal medicine. 14^th ed. 2. New York: McGraw-Hill; 1998: 1880-1888
• 2 Steiner G, Smolen J. Arthritis Res Ther 2002; 2: 1-5
• 3 Steiner G In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. eds. Rheumatology. London: Elsevier Sciences; 2003: 833-842
• 4 Dorner T. Crossroads of B cell activation in autoimmunity: rationale of targeting B cells. Curr Op Rheum 2004; 16: 246-253
• 5 Vossenaar ER, van Venrooij WJ. Arthritis. Res Ther 2004; 6: 107-111
• 6 Lovell DJ, Giannini EH, Reiff A et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. N Engl J Med 2000; 342: 763-769
• 7 Moreland LW, Baumgartner SW, Schiff MH et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)–Fc fusion protein. N Engl J Med 1997; 337: 141-147
• 8 Weinblatt ME, Kremer JM, Bankhurst AD et al. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 1999; 340: 253-259
• 9 Moreland L, Schiff MH, Baumgartner SW et al. Etanercept therapy in rheumatoid arthritis: a randomized, controlled trial. Ann Intern Med 1999; 130: 478-486
• 10 Braunstein J, Allendorf J, Reister M et al. How are soluble forms of ICAM-1 (sCD54) and LFA-3 (sCD58) generated?. Immunobiology 1994; 191: 193
• 11 Paleolog EM, Hunt M, Elliott MJ et al. Deactivation of vascular endothelium by monoclonal anti-tumor necrosis factor a antibody in rheumatoid arthritis. Arthritis Rheum 1996; 39: 1082-1091
• 12 Tak PP, Taylor PC, Breedveld FC et al. Decrease in cellularity and expression of adhesion molecules by anti-tumor necrosis factor a monoclonal antibody treatment in patients with rheumatoid arthritis. Arthritis Rheum 1996; 39: 1077-1081
• 13 Felson DT, Anderson JJ, Boers M et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum 1993; 36: 729-740
• 14 Fries JF, Spitz P, Kraines RG et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137-145
• 15 Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473-483
• 16 Ware Jr JE, Kosinski M, Keller SK. SF-36 physical and mental health summary scales: a user’s manual. Boston: Health Institute; 1994
• 17 Madhok R, Capell HA. Outstanding issues in use of disease-modifying agents in rheumatoid arthritis. Lancet 1999; 353: 257-258
• 18 Lovell DJ, Giannini EH, Reiff A et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. N Engl J Med 2000; 342: 763-769
• 19 Felson DT, Anderson JJ, Boers M et al. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995; 38: 727-735
• 20 Felson DT, Anderson JJ, Lange MLM et al. Should improvement in rheumatoid arthritis clinical trials be defined as fifty percent or seventy percent improvement in core set measures, rather than twenty percent?. Arthritis Rheum 1998; 41: 1564-1570
• 21 Finck BK, Weissman BNW, Rubenstein JD et al. 100 Micron digitization resolution is optimal for x-rays for a large multicenter trial in rheumatoid arthritis (RA). Arthritis Rheum 1997; 40 Suppl: S288
• 22 Pincus T, Callahan LF. Remodeling the pyramid or remodeling the paradigms concerning rheumatoid arthritis — lessons from Hodgkin’s disease and coronary artery disease. J Rheumatol 1990; 17: 1582-1585
• 23 Moreland LW, Baumgartner SW, Schiff MH et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)–Fc fusion protein. N Engl J Med 1997; 337: 141-147
• 24 Weinblatt ME, Kremer JM, Bankhurst AD et al. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 1999; 340: 253-259
• 25 Moreland L, Schiff MH, Baumgartner SW et al. Etanercept therapy in rheumatoid arthritis: a randomized, controlled trial. Ann Intern Med 1999; 130: 478-486
• 26 Maini RN, Breedveld FC, Kalden JR et al. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum 1998; 41: 1552-1563
• 27 Maini St R, Clair EW, Breedveld F et al. Infliximab (chimeric antitumour necrosis factor a monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomized phase III trial. Lancet 1999; 354: 1932-1939
• 28 Weinblatt ME, Kremer JM, Bankhurst AD et al. A trial of etanercept, a recombinant tumor necrosis factor receptor:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 1999; 340: 253-259
• 29 Targan SR, Hanauer SB, van Deventer SJH et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor a for Crohn’s disease. N Engl J Med 1997; 337: 1029-1035
• 30 van der Heijde D, van Riel P, Nuver-Zwat IH et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 1: 1036-1038
• 31 Wolfe F, Sharp JT. Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression. Arthritis Rheum 1998; 41: 1571-1582
• 32 Sharp JT, Wolfe F, Mitchell DM et al. The progression of erosion and joint space narrowing scores in rheumatoid arthritis during the first twenty-five years of disease. Arthritis Rheum 1991; 34: 660-668
• 33 Van der Heide A, Jacobs JW, Bijlsma JW et al. The effectiveness of early treatment with “second-line” antirheumatic drugs: a randomized, controlled trial. Ann Intern Med 1996; 124: 699-707
• 34 Plant MJ, Jones PW, Saklatvala J et al. Patterns of radiological progression in early rheumatoid arthritis: results of an 8 year prospective study. J Rheumatol 1998; 25: 417-426
• 35 Smolen JS, Kalden JR, Scott DL et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. Lancet 1999; 353: 259-266
• 36 Strand V, Cohen S, Schiff M et al. Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Arch Intern Med 1999; 159: 2542-2550
• 37 Bertolini DR, Nedwin GE, Bringman TS et al. Stimulation of bone resorption and inhibition of bone formation in vitro by human tumour necrosis factors. Nature 1986; 319: 516-518
• 38 Saklatvala J. Tumor necrosis factor alpha stimulates resorption and inhibits synthesis of proteoglycan in cartilage. Nature 1986; 322: 547-549
• 39 Wolfe F, Sharp JT. Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression. Arthritis Rheum 1998; 41: 1571-1582
• 40 van Leeuwen MA, van Rijswijk MH, Sluiter WJ et al. Individual relationship between progression of radiological damage and the acute phase response in early rheumatoid arthritis: towards development of a decision support system. J Rheumatol 1997; 24: 20-27