title: The effectiveness of anti-tumor necrosis factor therapy in preventing progressive radiographic joint damage in rheumatoid arthritis: a population-based study.
abstract: OBJECTIVE
  To compare the effectiveness of 3 therapeutic strategies in preventing progressive joint damage, in a population-based cohort. The 3 strategies were infliximab with concomitant disease-modifying antirheumatic drugs (DMARDs), etanercept with concomitant DMARDs, and etanercept alone.
  
  
  METHODS
  We used sequential radiographs to assess all patients who were treated with infliximab or etanercept for >10 months. The rates of erosion progression and joint space narrowing (JSN) were analyzed using multivariate regression models for longitudinal data, with adjustment for potential confounders.
  
  
  RESULTS
  A total of 372 patients treated with anti-tumor necrosis factor (TNF) therapies met the inclusion criteria. The baseline characteristics of the patients assigned to the 3 strategies were not significantly different, except that, as expected, more patients were receiving combination therapy with infliximab. The combination of infliximab plus DMARDs was significantly more effective than etanercept alone for controlling erosion progression (P < 0.001), but the effectiveness of the 2 combination-treatment strategies was similar (P = 0.07). The combination of infliximab plus DMARDs was also more effective at controlling progressive JSN compared with etanercept alone (P = 0.04) or etanercept plus DMARDs (P = 0.02). Treatment with anti-TNF agents (infliximab or etanercept) plus concomitant DMARDs was more effective than treatment with etanercept alone for controlling erosion progression (P = 0.045).
  
  
  CONCLUSIONS
  When combined with traditional DMARDs, both etanercept and infliximab appear to offer similar protection against progressive structural joint damage, and combination therapy with either of these agents appears to be more effective than treatment with etanercept alone.
authors.affiliation: Robert B. Brigham Atthritis and Musculoskeletal Diseases Clinical Research Center, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. afinckh@post.harvard.edu
authors.forename: Axel
authors.initials: A
authors.lastname: Finckh
authors.forename: Julia F
authors.initials: JF
authors.lastname: Simard
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Duryea
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Liang
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: Synove
authors.initials: S
authors.lastname: Daneel
authors.forename: Adrian
authors.initials: A
authors.lastname: Forster
authors.forename: Cem
authors.initials: C
authors.lastname: Gabay
authors.forename: Pierre-André
authors.initials: PA
authors.lastname: Guerne
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D000069285:Infliximab; D008137:Longitudinal Studies; D008297:Male; D011859:Radiography; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept