Among tumor necrosis factor alpha blockers, adalimumab (Humira) and etanercept (Enbrel)appear to be more effective and less expensive than infliximab(Remicade) for treatment of patients with rheumatoid arthritis (RA), Dutch researchers report in the September issue of Annals of the Rheumatic Diseases.
Dr. Wietske Kievit of Radboud University Nijmegen Medical Centre and colleagues came to this conclusion after studying prospectively gathered clinical practice data on 707 patients who were followed for at least 1 year; 38% started with adalimumab, 41% with etanercept, and the remaining 21% with infliximab.
Over the 12 months of follow-up, Disease Activity Score (DAS28) and the Short-Form 36 score fell in all groups, but the reduction was significantly greater with adalimumab or etanercept than with infliximab. Other instruments indicated a trend towards improved functionality and quality of life in the adalimumab and etanercept groups.
The team also found a significant difference between adalimumab and etanercept in DAS28 score, with adalimumab having the advantage. However, there were no significant differences in other measures.
Furthermore, median costs for infliximab (14,220 euros) were significantly greater than for adalimumab (13,871 euros) and etanercept (13,938 euros). This was also true of total RA medication costs per group.
The researchers observe that adalimumab and etanercept are essentially comparable, and Dr. Kievit told Reuters Health that overall, evaluation of effectiveness and costs "revealed better outcomes than infliximab in the first year of treatment."
"Future research," she concluded, "should consider whether a different dosing scheme for infliximab -- higher doses or shorter intervals -- is equally effective in daily clinical practice as adalimumab or etanercept."
Ann Rheum Dis 2008;67:1229-1234.
Thanks Lynn! This is perfect timing. I was just put to the max dosage on Remicade and fully expect to have a conversation about moving to a new med within the next 3 months if no improvement. I had plans to start research on options in preparation for the conversations. This gets me started.