title: Effects of half dose etanercept (25 mg once a week) on clinical remission and radiographic progression in patients with rheumatoid arthritis in clinical remission achieved with standard dose.
abstract: OBJECTIVE
  This prospective long-term follow-up study evaluated the effects of half-dose etanercept (25 mg weekly) on clinical remission and radiographic progression in a large cohort of patients with rheumatoid arthritis (RA) in clinical remission after etanercept 25 mg bi-weekly.
  
  
  METHODS
  524 biologic-naïve RA patients were treated with etanercept 25 mg bi-weekly after failure of conventional drugs. Patients achieving remission (DAS28 <2.6) for ≥12 months were randomised to receive etanercept 25 mg weekly or 25 mg bi-weekly. Patients were assessed at baseline and every 12 weeks. Remission rates, radiographic progression, incidence of infections and costs of the regimens were compared.
  
  
  RESULTS
  After a mean follow-up of 18±11 months, 347 patients (66.2%) achieved DAS28 remission; 323 were randomised to one of two dose regimens: etanercept 25 weekly (group A, 159 patients) and etanercept 25 mg bi-weekly (group B, 164 patients). At the end of follow-up, 81.8% patients of group A maintained remission for a mean of 3.6±1.5 years. Radiographic progression occurred in a small number of patients of group A and the rate of radiographic progression (TSS >0) was not significantly different in the two groups (18.85% vs. 19.0% after the first year and 16.9% vs. 21.6% after the second year, respectively). The incidence ratio of severe infections was 2.3/1.000 patient-years in group A. Etanercept half-dose regimen resulted in a saving of €3.190.545 with a cost saving up to €827.318 per year.
  
  
  CONCLUSIONS
  Clinical remission and arrest of radiographic progression persisted in a substantial percentage of patients with RA even after reduction of standard-dose etanercept.
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Bernd
authors.initials: B
authors.lastname: Raffeiner
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Botsios
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ometto
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Bernardi
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stramare
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Todesco
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sfriso
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000191:economics / Q000276:immunology; D001175:Arthrography; D003141:Communicable Diseases / Q000139:chemically induced / Q000276:immunology; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004334:Drug Administration Schedule; D016527:Drug Costs; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D007558:Italy; D007596:Joints / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept