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Early Arthritis
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Etanercept(Enbrel) Curbs Early Rheumatoid Arthritis NEJM 11/30/2000 By Anne MacLennan Subcutaneous etanercept(Enbrel) decreases symptoms and slows joint damage more rapidly than does oral methotrexate in patients with early active rheumatoid arthritis, a study has found. Etanercept, which blocks the action of tumor necrosis factor, is known to reduce disease activity in long-standing rheumatoid arthritis. However, its efficacy in curbing disease activity and preventing joint damage in people with active early rheumatoid arthritis has been unknown. In this investigation, 632 patients with early rheumatoid arthritis were treated with either twice-weekly subcutaneous etanercept (10 or 25 mg) or weekly oral methotrexate (a mean 19 mg per week) for one year. Clinical response was defined as the percent improvement in disease activity according to the American College of Rheumatology. Bone erosion and joint-space narrowing were measured radiographically and scored via the Sharp scale, on which an increase of one point represents one new erosion or minimal narrowing. Patients on the 25-mg dose of etanercept versus those on methotrexate had a more rapid rate of improvement, with significantly more of them having 20 percent, 50 percent and 70 percent improvement in disease activity in the first six months. Mean increase in erosion score in the first six months was 0.30 in those on 25 mg etanercept versus 0.68 in those on methotrexate. In the first 12 months, mean increase in erosion score was 0.47 versus 1.03, respectively. Among patients on 25-mg etanercept, 72 percent had no increase in erosion score versus 60 percent of patients on methotrexate; they also had fewer adverse events and infections than did the group on methotrexate. [See related story: Drug Mix Halts Joint Erosion In Persistent Arthritis.] N Engl J Med 2000;343:1586-93. |
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