Does reducing etanercept maintain remission in early rheumatoid arthritis?

This study assessed the effects of reducing and withdrawing treatment in rheumatoid arthritis (RA) patients who had achieved remission using etanercept (Enbrel) plus methotrexate (Trexall). The results showed that etanercept and methotrexate (MTX) combined led to better disease control than MTX alone, or a placebo (a substance that has no effect). There was no difference noted between the treatments and the disease progression. 

RA causes joint damage and increases disability levels the longer the disease is active. Early aggressive treatment is better for maintaining the joints and keeping joint mobility, so remission (a reduction in disease symptoms) is the main target in early RA treatment.

One category of drugs used to treat RA is tumor necrosis factor inhibitors, such as etanercept . These drugs combined with MTX can result in high levels of remission. When remission is achieved, it is unclear whether a reduced dose or withdrawal of the drugs can maintain remission. Patients would prefer to reduce their drug intake due to safety concerns and the cost of the drugs. 

This study examined the effects of reducing and withdrawing treatment on disease remission.

This study was in three parts. In the first part, 306 patients with early RA received etanercept and MTX for 1 year. In the second part, those that responded well (193 patients) were split into three groups: an etanercept (at a reduced dose) and MTX group, an MTX alone group, or a placebo (substance with no effect on the body) group. The groups received treatment for 39 weeks. In the third part, all treatment was withdrawn from the 83 patients still in remission. The patients were monitored for a further six months.

At the end of the study (65 weeks), 44% of patients taking the combined treatment had maintained remission. In comparison, remission was maintained in 29% of those taking MTX alone and 23% taking the placebo. There was no difference in disease progression based on joint damage seen on x-ray.

The study concluded that the drug combination (etanercept and MTX) resulted in better disease control when the dose was reduced compared to taking MTX alone or not taking any drug. There was no difference in the progression of the disease between the groups. 

This study was funded by Pfizer.