Defusing RA with Enbrel

Enbrel plus methotrexate for rheumatoid arthritis led to sustained low disease activity

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) The main goals of treatment for rheumatoid arthritis are remission and low disease activity. That is, treatment is meant to reduce signs and symptoms of the disease. One arthritis med may help patients reach these goals.

Methotrexate is typically the first choice of medication to treat rheumatoid arthritis. When methotrexate alone doesn't work, doctors may choose to add another medication to the treatment plan. Enbrel (etanercept) is one of these medications.

A recently published study showed that Enbrel plus methotrexate can help rheumatoid arthritis patients achieve low disease activity. Low disease activity was maintained even after Enbrel doses were lowered. However, when Enbrel was completely cut from treatment, fewer patients maintained low disease activity.

"Ask your doctor about treatment options for rheumatoid arthritis."

The study was conducted by Josef S. Smolen, MD, from Medical University of Vienna and Hietzing Hospital in Austria, and colleagues.

In background information of the study, the researchers wrote, "Clinical remission and low disease activity are essential treatment targets in patients with rheumatoid arthritis. Although moderately active rheumatoid arthritis is common, treatment effects in moderate disease have not been well studied."

So, Dr. Smolen and his fellow researchers set out to see if low disease activity could be sustained while either lowering doses or completely removing Enbrel from treatment in patients with moderately active rheumatoid arthritis.

To measure disease activity, the researchers used the Disease Activity Score in 28 joints (DAS28) - a measure of rheumatoid arthritis disease activity that counts the total number of tender or swollen joints out of a total of 28 joints. DAS28 scores range from 0 to 10. A DAS28 score between 3.2 and 5.1 is considered moderate disease activity, while a score between 2.6 and 3.2 is considered low disease activity.

For the first part of the study, 834 rheumatoid arthritis patients were given 50 mg of Enbrel plus methotrexate every week for 36 weeks. To be included in the second part of the study, participants had to have achieved low disease activity.

A total of 605 patients made it to the second part of the study. During this study period, patients were given either 50 mg of Enbrel plus methotrexate, 25 mg of Enbrel plus methotrexate or placebo (sugar pill) plus methotrexate.

After 88 weeks, low disease activity was seen in 166 (82.6 percent) of the 201 patients who were given at least one dose of 50 mg Enbrel and had at least one DAS28 evaluation. In comparison, 84 (42.6 percent) of the 197 patients who received placebo achieved low disease activity.

Low disease activity was also achieved by 159 (79.1 percent) patients who were given 25 mg of Enbrel plus methotrexate.

According to the authors, "Conventional or reduced doses of etanercept with methotrexate in patients with moderately active rheumatoid arthritis more effectively maintain low disease activity than does methotrexate alone after withdrawal of etanercept."

The study was published January 17 in The Lancet. The work was funded by Pfizer, the manufacturer of Enbrel. A number of the study's authors are employees of Pfizer.

Reviewed by: 
Review Date: 
January 18, 2013
Last Updated:
January 21, 2013