Early Arthritis

 

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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