Effect of different etanercept doses in rheumatoid arthritis

The authors investigated the effect of etanercept (Enbrel) dose change on patients with rheumatoid arthritis (RA). 

In RA, high levels of immune system protein are generated, which causes inflammation, leading to chronic pain. Several studies indicated that etanercept in combination with the standard antirheumatic drug methotrexate (Trexall) provided better response rates compared to either drug when used alone. Clinicians can assess patient response to therapy based on disease activity scores, such as DAS28. This is an assessment that measures the progress and improvement of RA by examining 28 joints. The goal is a low disease activity (LDA), meaning that the signs and symptoms of RA have reduced or stopped for as long as possible. A DAS28 score of 3.2 or less is considered LDA. Patients who achieve LDA from this combination treatment tend to still continue treatment at the same dose. However, it would be beneficial if patients could either discontinue the treatment or continue at a lower dose once RA is under control.

Further studies in this aspect are needed to determine a lower dose treatment in RA patients who achieve LDA. 

The authors aimed to analyze the effect of etanercept on RA patients who had already achieved LDA on combination treatment with etanercept and methotrexate.

73 RA patients with stable LDA were included in this study. After 8 weeks of combination treatment, 23 patients received 50mg of etanercept once a week plus methotrexate (group 1). 27 patients received 25mg of etanercept once a week plus methotrexate (group 2). 23 patients received placebo treatment (harmless pill used instead of the active drug) once a week plus methotrexate (group 3). All patients received treatments for 48 weeks. Patients whose signs and symptoms of RA did not increase were considered non-failures.

52% of patients in group 1 and 44% of patients in group 2 were non-failures. This was compared to 13% in group 3. The median (mid-point) time to achieve failure was 6 weeks in group 3. This was compared to 48 weeks in group 1 and 36 weeks in group 2.

Treatments were generally well tolerated. Some of the severe side effects included back pain and infection in the uterus. 

The authors concluded that a reduced dose of etanercept with methotrexate could be possible in RA patients to maintain a stable LDA state. 

If you have achieved stable LDA on combination treatment with etanercept 50 mg plus methotrexate,  talk to your doctor about lowering the dose of etanercept.