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Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis
Karolinska Inst, Inflammatory Dis ClinTRID, Unit Clin Therapy Res, S-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Rheumatol Clin, Stockholm, Sweden..
Univ Copenhagen, Glostrup Hosp, Ctr Rheumatol & Spine Dis, Fac Hlth Sci,Copenhagen Ctr Arthrit Res, Copenhagen, Denmark..
Univ Helsinki, Cent Hosp, Helsinki, Finland.;Univ Helsinki, Inst Clin Med, Helsinki, Finland..
Diakonhjemmet Hosp, Dept Rheumatol, Natl Advisory Unit Rehabil Rheumatol, Oslo, Norway..
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2016 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no 1, 52-58 p.Article in journal (Refereed) PublishedText
Abstract [en]

Background The aim of the Dose Reduction or Discontinuation of Etanercept in Methotrexate-Treated Rheumatoid Arthritis Patients Who Have Achieved a Stable Low Disease Activity-State study was to investigate the effect of etanercept (ETN) dose maintenance, reduction or withdrawal on patients with rheumatoid arthritis (RA) who had already achieved stable low disease activity (LDA) on ETN 50 mg + methotrexate (MTX). Methods Patients with RA (n=91) and stable LDA with ETN 50 mg once weekly (QW)+ MTX were included. After 8 weeks with unchanged treatment, 73 patients were randomised in a double-blind design to ETN 50 mg QW+MTX (ETN50), ETN 25 mg QW+MTX (ETN25) or placebo QW+MTX (PBO) for 48 weeks. Patients who flared were declared failures and treated with open-label ETN50 until week 48. The primary outcome was the proportion of patients on ETN50 versus PBO who were non-failures after 48 weeks. Results The proportion of non-failure patients was significantly lower with ETN50 (52%; p=0.007) and ETN25 (44%; p=0.044) versus PBO (13%). Median time to failure was significantly shorter with PBO (6 weeks) compared with ETN50 (48 weeks; p=0.001) and ETN25 (36 weeks; p<0.001). The majority of patients who flared regained LDA with open-label ETN50 quickly. Adverse events were consistent with the known side effect profiles of these medications. Conclusions In patients with established RA who have achieved stable LDA on ETN50+MTX, continuing both is superior to PBO+MTX. Reduced dose ETN was also more effective than PBO in maintaining a favourable response, suggesting that a maintenance strategy with reduced dose ETN may be possible in a number of patients with established RA.

Place, publisher, year, edition, pages
2016. Vol. 75, no 1, 52-58 p.
National Category
Rheumatology and Autoimmunity
URN: urn:nbn:se:uu:diva-274269DOI: 10.1136/annrheumdis-2014-205726ISI: 000366402400047OAI: oai:DiVA.org:uu-274269DiVA: diva2:912674
Available from: 2016-03-17 Created: 2016-01-20 Last updated: 2016-03-17Bibliographically approved

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