title: Long-term treatment response in rheumatoid arthritis patients starting adalimumab or etanercept with or without concomitant methotrexate.
abstract: OBJECTIVE
  To observe long-term clinical response and drug survival in a prospective two-year cohort study in rheumatoid arthritis (RA) patients starting adalimumab or etanercept treatment, with or without methotrexate (MTX), after failure of conventional DMARD therapy, including MTX.
  
  
  METHODS
  Disease activity score of 28 joints (DAS28) and Health Assessment Questionnaire (HAQ) were collected of 873 consecutive RA patients, treated with adalimumab or etanercept, prospectively at baseline, 4, 16, 28, 40, 52, 78 and 104 weeks of biological therapy. Sustained minimal disease activity (MDA), DAS28 <2.6 for at least 24 consecutive weeks, biological discontinuation, ΔHAQ and ΔDAS28 were compared between patients treated with or without concomitant MTX for etanercept and adalimumab separately.
  
  
  RESULTS
  More patients treated with adalimumab and MTX (42%) achieved sustained MDA than patients without MTX (18%). The hazard ratio (HR) was 2.3 [1.4-3.9]. No significant difference was found in etanercept treatment (with MTX 33% vs. 28% without MTX), HR 1.1 [0.8-1.6]. More patients treated without MTX discontinued treatment than patients with MTX co-treatment in adalimumab (HR 2.1 [1.5-3.0]) and etanercept (HR 1.9 [1.0-3.4]). The mean decrease in DAS28 over time was higher for patients treated with MTX in adalimumab (regression coefficient (RC): 0.57, p<0.001), but was not significantly different in etanercept treatment (RC 0.05, p=0.427). No significant differences were found in ΔHAQ.
  
  
  CONCLUSIONS
  Treatment discontinuation is lower in patients treated with MTX in both adalimumab and etanercept treatment. However, considering good clinical response, in contrast to etanercept, a synergetic effect of MTX is observed only in adalimumab treatment.
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands. m.lami@reade.nl.
authors.forename: Merel J
authors.initials: MJ
authors.lastname: l'Ami
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
authors.forename: Eva L
authors.initials: EL
authors.lastname: Kneepkens
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade; and Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
authors.forename: Charlotte L M
authors.initials: CLM
authors.lastname: Krieckaert
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Visman
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade; and Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Wolbink
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate