Remission with etanercept – what degree of remission predicts long-term success?

This study investigated if initial remission can predict long-term remission (LTR) after etanercept (Enbrel) treatment. 

They found that LTR is more likely if strict disease control is achieved before etanercept withdrawal

Rheumatoid arthritis (RA) is a long-term condition. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. There are many types of DMARDs. One of these is biological DMARDs (bDMARDs). Etanercept is a bDMARD that blocks tumor necrosis factor (TNF). This is an inflammatory molecule.

The aim of RA treatment is to achieve remission (no symptoms). If remission is achieved, DMARDs can be reduced or withdrawn. Some patients may have long-term remission (LTR). Others may have flares with RA symptoms. It is difficult to determine if a patient will continue to LTR or RA flares. It is unclear if there is a certain level of disease control that predicts if a patient will have LTR.

This study analyzed data from 1117 patients with RA in 3 clinical trials. All patients were treated with etanercept until remission. Etanercept was reduced or withdrawn depending on disease activity (DA). DA was assessed using different rating scales. These included ACR/EULAR, CDAI, and DAS28 scores. Remission rates were compared to the remission criteria for each DA scale.

Achieving sustained deep remission (SDR) with etanercept was the best predictor of LTR. Patients achieving SDR had a better chance of LTR compared to those with low DA. Continued etanercept treatment was also associated with a better chance of LTR. These findings were observed in all 3 studies. 

The authors concluded that LTR is more likely if a strict disease control is achieved before etanercept withdrawal.

This study investigated patients on etanercept. It is unclear if the same DA criteria should be used for patients taking other bDMARDs. The patients in these studies had moderate-severe RA and the findings may not be applicable to early RA.

If you have any concerns regarding RA management please consult with your physician.