[Clinical experience with TNF-alpha inhibitors in rheumatoid arthritis].
BACKGROUND
Infliximab and etanercept, both tumour necrosis factor-alpha inhibitors, are proven to be effective in patients with rheumatoid arthritis in randomised controlled trials.


METHODS
Patients with active rheumatoid arthritis were treated with infliximab (n = 29) or etanercept (n = 24) in clinical hospital practice. They were examined before and during treatment. All patients had tried at least one DMARD before. Details of disease activity were monitored by measuring tender and swollen joints, global and pain patient visual analogue scales, Disease Activity Index Score (DAS 28), the Modified Health Assessment Questionnaire, blood and urine samples, and adverse effects. The patients were monitored regularly for two years or until they stopped treatment.


RESULTS
In the infliximab group we observed statistically significantly better values for all the registered variables after 6 weeks. At the other times of registration the variables were varying a lot; however, DAS 28 scores after baseline were all within the limits of moderate effect. In the etanercept group we observed statistically significantly better values for all the variables except for erythrocyte sedimentation rate after 6 weeks. At the other times of registration all the variables had significantly better values. Adverse effects were reported in 9 patients in the infliximab group and in 5 in the etanercept group, but no serious adverse effects were reported. 18 patients in the infliximab group (61%) and 10 in the etanercept group (42%) had stopped treatment within two years, either because of adverse effects or lack of effect.


CONCLUSIONS
In this open study of patients with active rheumatoid arthritis, most experienced a rapid effect of infliximab, but a varying effect later on. In the etanercept group the patients experienced both a rapid and sustained effect among those who tolerated the medication. Compared to what several others have reported, a large number of patients stopped treatment; this may reflect limited experience.
Klinikk for ortopedi og revmatologi, Revmatologisk avdeling, St. Olavs Hospital, 7006 Trondheim. marianne.wallenius@stolav.no
Marianne
M
Wallenius
Erik
E
Rødevand
Johan Fredrik
JF
Skomsvoll
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D047889:Receptors, Tumor Necrosis Factor, Type II; D016896:Treatment Outcome; D053319:Tumor Necrosis Factor Decoy Receptors
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D009363:Neoplasm Proteins; D018124:Receptors, Tumor Necrosis Factor; D047889:Receptors, Tumor Necrosis Factor, Type II; D053319:Tumor Necrosis Factor Decoy Receptors; D000069285:Infliximab; D000068800:Etanercept