Question about Enbrel... | Arthritis Information

For those of you taking Enbrel, or that may know, Has your doctor set a guideline of how bad your RA should be before trying Enbrel?( Mild, moderate or severe etc... ) Does your doctor think you should try all different medication routes first before getting on Enbrel? Is this a last resort drug?

Anti-TNF agents in early RA. The TFP limited its recommendation

for the use of anti-TNF agents (interchangeably)

with methotrexate in patients with early RA

to those who had never received DMARDs and had high

disease activity (level C* evidence). Patients with early RA

and only low or moderate disease activity were not considered

candidates for biologic therapy (Figure 3A). The

use of an anti-TNF agent in combination with methotrexate

was recommended if high disease activity was present

for 3 months with features of both a poor prognosis and

an absence of either barriers related to treatment cost and

no insurance restrictions to accessing medical care

(68,70,72,74). This decision by the TFP and CEP was sup-

ported by the results of pharmacoeconomic evaluations

conducted on US populations (77–79).

Anti-TNF agents in intermediate- and longer-duration

RA. In intermediate-duration and longer-duration RA, the

TFP recommended the use of the anti-TNF agents (interchangeably)

in patients for whom prior methotrexate

monotherapy led to an inadequate response, with moderate

disease activity and features of a poor prognosis, and

for patients with high disease activity, irrespective of prognostic

features. The TFP also recommended use of anti-

TNF agents (interchangeably) in patients for whom prior

methotrexate therapy was used in combination, or if sequential

administration of other nonbiologic DMARDs led

to an inadequate response with at least moderate residual

disease activity irrespective of prognostic features (level A

evidence for high disease activity) (74,76,80–101) (Figure

3C). The anti-TNF agents (etanercept, infliximab, and

adalimumab) are efficacious in improving disease activity,

function, and quality of life and/or retarding radiographic

progression when used alone (83,89), in combination with

methotrexate (80,81,96–99,102–108), or in patients for

whom treatment with DMARDs other than methotrexate

led to an inadequate response (93,109). Although the majority

of clinical trials have focused on adding biologic

agents to methotrexate, no distinction was made by the

panel regarding the decision to add biologic agents to

methotrexate or to substitute for methotrexate with other

nonbiologic DMARDs.