Safety and efficacy of etanercept beyond 10 years of therapy in North American patients with early and longstanding rheumatoid arthritis.
OBJECTIVE
To evaluate the long-term safety and efficacy of etanercept therapy in rheumatoid arthritis (RA) patients.


METHODS
Adult patients with early RA or longstanding RA received etanercept in open-label extension studies following initial double-blind trials of etanercept.


RESULTS
Of 558 early RA patients and 714 longstanding RA patients who received at least 1 dose of etanercept, a total of 194 early RA patients and 217 longstanding RA patients were treated with 25 mg of etanercept twice weekly through 10 years. Five opportunistic infections were reported: in early RA, 1 Candida septicemia; in longstanding RA, 1 herpes zoster, 1 atypical mycobacterium infection, 1 meningoencephalitis (unspecified), and 1 fungal sepsis (unspecified). Twenty-nine cases of sepsis occurred (10 early RA, 19 longstanding RA). Occurrence of all malignancies was similar to that expected in the general population, but the occurrence of lymphomas was higher than expected in the general population. Fourteen lymphomas (7 early RA, 7 longstanding RA) and 2 cases of demyelinating disease (1 early RA, 1 longstanding RA) were reported. Deaths occurred in 18 early RA patients and 43 longstanding RA patients. Both patient groups showed sustained improvement in American College of Rheumatology responses, swollen joint counts, Health Assessment Questionnaire disability index scores, and C-reactive protein levels.


CONCLUSIONS
Etanercept maintained therapeutic benefits beyond 10 years of therapy in both early RA and longstanding RA patients, suggesting that etanercept is well tolerated and effective as a long-term, continuous therapy for the treatment of RA, with a favorable risk/benefit ratio.
Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA. mweinblatt@partners.org
Michael E
ME
Weinblatt
Joan M
JM
Bathon
Joel M
JM
Kremer
Roy M
RM
Fleischmann
Michael H
MH
Schiff
Richard W
RW
Martin
Scott W
SW
Baumgartner
Grace S
GS
Park
Edward L
EL
Mancini
Mark C
MC
Genovese
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D004185:Disability Evaluation; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced; D009656:North America; D009894:Opportunistic Infections / Q000139:chemically induced; D011237:Predictive Value of Tests; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000139:chemically induced; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept