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The Efficacy of Switching from Etanercept to Infliximab in Patients with Rheumatoid Arthritis
KAREN E. HANSEN, JULIE P. HILDEBRAND, MARK C. GENOVESE, JOHN J. CUSH, SUPEN PATEL, DAVID A. COOLEY, STANLEY B. COHEN, RONALD E. GANGNON, and MICHAEL H. SCHIFF
ABSTRACT.
Methods. In a retrospective study among 6 centers primarily designed to assess the safety of infliximab in combination with leflunomide, a standardized chart review form was used to collect data on 93 patients with RA. During that study, it was noted that some of these patients had switched from etanercept to infliximab. In this study, we compared the response of subjects switching from etanercept to infliximab (n = 20) to that of subjects receiving infliximab with no prior tumor necrosis factor (TNF) therapy (n = 73). Results. The swollen and tender joint count, patient and physician global assessments, morning stiffness, and C-reactive protein all improved substantially in both groups, with no statistical difference in the degree of benefit between the groups. At the time of chart review, switchers had received a statistically higher dose of infliximab than controls (4.4 vs 3.19 mg/kg; p = 0.006) with a total of 5.7 and 5 infusions, respectively. Conclusion. In this retrospective study, previous lack of efficacy with etanercept did not predict lack of efficacy with infliximab. Indeed, the degree of clinical improvement was similar in both groups, although switchers were receiving a higher dose of infliximab at the time of chart review. Our findings suggest that clinical response may differ between anti-TNF agents, and lack of response to one agent may not predict a lack of response to another. (J Rheumatol 2004;31:1098-102) Key Indexing Terms:
RHEUMATOID ARTHRITIS From the Division of Rheumatology, University of Wisconsin, Madison, Wisconsin; Stanford University, Stanford, California; Division of Rheumatology and Clinical Immunology, Presbyterian Hospital of Dallas and the University of Texas Southwestern Medical School, Dallas, Texas; Carolina Health Care, Florence, South Carolina; Mid-American Rheumatology Consultants, Overland Park, Kansas; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin; and Denver Arthritis Clinic, Denver, Colorado, USA. Supported by an unrestricted grant from Aventis. K.E. Hansen, MD, Assistant Professor of Medicine, University of Wisconsin, Chief of Rheumatology, Veterans Hospital; J. Hildebrand, MD, Rheumatology Fellow, University of Wisconsin; M.C. Genovese, MD, Associate Professor of Medicine, Chief of Clinical Services, Division of Immunology and Rheumatology, Stanford University; J.J. Cush, MD, Chief of Rheumatology and Clinical Immunology, Presbyterian Hospital of Dallas, Clinical Professor of Medicine, University of Texas Southwestern Medical School; S. Patel, MD, Rheumatologist, Carolina Health Care; D. Cooley, MD, Rheumatologist, Mid-American Rheumatology Consultants; S. Cohen, MD, Clinical Professor of Medicine, University of Texas Southwestern Medical School; R.E. Gangnon, PhD, Associate Scientist, Department of Biostatistics and Medical Informatics, University of Wisconsin; M. Schiff, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Director of Clinical Research, Denver Arthritis Clinic. Address reprint requests to Dr. K.E. Hansen, Room B5055, Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705. E-mail: keh@medicine.wisc.edu Submitted March 28, 2003; revision accepted November 4, 2003.
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