title: Effectiveness of anti-tumor necrosis factor agents in the treatment of rheumatoid arthritis: observational study.
abstract: OBJECTIVE
  The efficacy of anti-tumor necrosis factor therapies in rheumatoid arthritis has been demonstrated in randomized clinical trials. The purpose of the present study was to evaluate the effectiveness of these agents for the treatment of rheumatoid arthritis in a real-world setting.
  
  
  METHODS
  This retrospective chart review included patients from 6 clinics in the United States. Eligibility criteria included age ≥18 years, diagnosis of rheumatoid arthritis, and having been initiated with anti-tumor necrosis factor therapy (ie, adalimumab, etanercept, or infliximab) between January 1, 2002, and November 30, 2004. Patients were assessed for up to 2 years after therapy initiation. Primary outcomes of interest were improvements in 4 effectiveness measures-joint pain, joint swelling, joint stiffness, and fatigue. A total of 496 patients met the study's inclusion criteria: 84 (16.9%) in the adalimumab group, 146 (29.4%) in the etanercept group, and 266 (53.6%) in the infliximab group.
  
  
  RESULTS
  Improvement in 1 of the 4 effectiveness measures was documented in 36.8% (n = 25) who received adalimumab, in 47.7% (n = 62) of those who received etanercept, and in 48.7% (n = 115) of patients who received infliximab. The infliximab group was the only cohort to demonstrate significant improvements from baseline in joint pain, joint swelling, and joint stiffness. The adalimumab group had significant improvement in joint pain (P = .004). No significant change in fatigue scores was reached with any of these agents.
  
  
  CONCLUSIONS
  In the real-world setting of patients with rheumatoid arthritis, anti-tumor necrosis factor therapy shows significant improvements in joint pain, joint swelling, and joint stiffness, although there are differences in effectiveness in the 4 measures among the 3 agents assessed in this study.
authors.affiliation: Manager, Xcenda, Palm Harbor, FL.
authors.forename: Anna
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Director (when this research was conducted), Xcenda, Palm Harbor, FL.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Meissner
authors.affiliation: Director of Outcomes Research, Medical Affairs Operations, Centocor Ortho Biotech, Horsham, PA.
authors.forename: Boxiong
authors.initials: B
authors.lastname: Tang
authors.affiliation: Regional Director, Clinical Affairs, Centocor Ortho Biotech, Horsham, PA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McKenzie
authors.affiliation: Vice President, Outcomes Research and Biometrics, Centocor Ortho Biotech, Horsham, PA.
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Piech