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Many RA Patients Maintain Remission at Half Dose of Etanercept

Nearly half of rheumatoid arthritis patients were able to retain remission for 3 months on a 25 mg weekly dose plus methotrexate. Returning to full dose quickly resolved disease for those who flared.

van Vollenhoven RF, Østergaard M, Leirisalo-Repo M, et al., Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis. Ann Rheum Dis 2015; Online April 14. doi:10.1136/annrheumdis-2014-205726

Some patients with established rheumatoid arthritis (RA) may be able to sustain low-disease activity for as long as 3 months on a reduced dose of the anti-tumor necrosis factor-alpha (TNF-α) drug etanercept (Enbrel) plus methotrexate (MTX), this study suggests.

It found that around half of RA patients in remission (defined as a disease activity in 28 joints or DAS28 score <2.6) remain stable for 48 weeks with the standard doses.

At half that dose, 44% of RA patients in remission can achieve and maintain stable low disease activity (LDA) for 36 weeks, the study suggests.

Discontinuing ETN is associated with a much higher risk of flare than continued treatment, the authors write.

In the DOSERA* study coordinated at Sweden's Karolinska Institute, 73 patients were randomized after 8 weeks of ETN at 50 mg/week to either continue that dose, receive 25 mg ETN, or get placebo.

All patients continued to take stable doses of oral MTX (7.5–25 mg/week) plus other medications.

A majority of the patients were women (mean age 57) who’d had RA for an average of 13.6 years. They had been taking ETN for around 3 years at the start of the study.

The primary outcome was avoiding “flare” (DAS28 >3.2), which was defined as “failure." Patients who flared were given open-label ETN50 until week 48. The majority regained LDA quickly on ETN 50 mg, the researchers note.

The study was not powered to show difference or equivalence between the two ETN doses.

ETN is not approved for RA in single or divided weekly doses of less than 50 mg. But given the cost of TNF-α inhibitors, the finding that lower doses are equally effective for maintenance has important implications, the authors say.

*(DOSERA stands for Dose Reduction or Discontinuation of Etanercept in Methotrexate-Treated Rheumatoid Arthritis Patients Who Have Achieved a Stable Low Disease Activity-State)