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Dr. Keystone replies To the Editor: Bawa, et al report an interesting but small study of 15 patients who switched from etanercept 25 mg subcutaneous twice per week to 50 mg once per week. This report is the first to address the issue of switching from 25 mg twice a week to 50 mg once-weekly dosing. The authors demonstrated that one-third of patients switching from 25 mg twice per week to 50 mg weekly exhibited a flare. However, the sample size was too small to provide an accurate assessment of the proportion of patients who might experience flare on the 50 mg dose. Although our previous study of 420 patients demonstrated comparable responses with the 25 mg twice per week dose and the 50 mg once-weekly dose, the therapeutic paradigm of our study differs from that of Sundeep, et al, since, as they point out, the 50 mg once-weekly dose was used only after a good response was achieved with the standard 25 mg dose. This difference in therapeutic strategies between the 2 studies precludes drawing direct comparisons, as Sundeep, et al pointed out. EDWARD C. KEYSTONE, MD, Mount Sinai Hospital, 60 Murray Street, Room 2-006, Toronto, Ontario M5G 1X5, Canada. E-mail: edkeystone@mtsinai.on.ca |