RA Drugs Carry Similar Risk

Rheumatoid arthritis patients taking different TNF inhibitors may have similar risk of death

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Many experts recommend that rheumatoid arthritis patients get early drug treatment to slow down their disease and prevent disability. With so many drug options, it's important to know the safety of each drug.

Researchers found no difference in death rates among rheumatoid arthritis patients taking either Humira (adalimumab), Enbrel (etanercept) or Remicade (infliximab).

"Weigh the benefits of your arthritis drug options."

Humira, Enbrel and Remicade are part of a class of drugs called tumor necrosis factor (TNF) inhibitors. TNF is a molecule that promotes inflammation, a key characteristic of rheumatoid arthritis.

While these three drugs work similarly, their are differences in their modes of action (how they attack disease) and safety. Dr. Julia F. Simard, of Karolinska Institutet in Sweden, and colleagues wanted to see if these differences led to different risks of death among patients taking each drug.

Over the course of their study, 211 of 6,322 (3.3 percent) patients died. Of these deaths, 85 percent happened to patients taking just one TNF inhibitor.

The researchers found that the risk of death was more or less the same across each group of patients.

The relative risk of death of Remicade versus Enbrel was 1.1. The relative risk of death of Humira versus Enbrel was 1.3.

In this case, relative risk explains the risk of death among patients taking one drug versus the risk of death in those taking another drug. A relative risk of 2.0 means that the risk is doubled. So, a relative risk of 1.1 or 1.3 means there was little difference in risk.

"Understanding risk versus benefits of treatment with the most commonly prescribed biologics [medications] is important for physicians and patients in management rheumatoid arthritis," said Dr. Simard.

Even though the findings showed no major difference in death rates across the three drug treatments, more research is needed to see if this remains true in different types of rheumatoid arthritis patients, Dr. Simard concluded.

For their study, Dr. Simard and colleagues compared data of patients with rheumatoid arthritis who started their first TNF inhibitor treatment between 2003 and 2008. The researchers gathered information on deaths from any cause, demographics, rheumatoid arthritis characteristics, comorbidities (other health problems) and other treatments from 1,609 patients taking Humira, 2,686 patients taking Enbrel and 2,027 patients taking Remicade.

The study was funded by the Strategic Research Program in Epidemiology at Karolinska Institutet, the Swedish Foundation for Strategic Research, the national public-private research consortium COMBINE and the Swedish Society for Rheumatology.

The research was published August 8 in Arthritis & Rheumatism, a journal of the American College of Rheumatology. 

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Review Date: 
August 14, 2012
Last Updated:
August 19, 2012