Document Detail

Comparative effectiveness of tumour necrosis factor alpha inhibitors in combination with either methotrexate or leflunomide.
MedLine Citation:
PMID:  19126559     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The objective of this study was to compare the effectiveness of a combination of tumour necrosis factor alpha (TNFalpha) inhibitors with either methotrexate or leflunomide in the treatment of patients with rheumatoid arthritis in a real-world setting.
METHODS: Data from 1769 outpatients enrolled in the German biologics register RABBIT who were treated with one of the TNFalpha inhibitors adalimumab, etanercept, or infliximab in combination with either methotrexate (n = 1375) or leflunomide (n = 394) were included in the analysis. Clinical status including disease activity as well as treatment data were documented by the treating rheumatologist at baseline and at 3, 6, 12, 18, 24, 30 and 36 months of follow-up.
RESULTS: Patients treated with a combination of biologics with leflunomide had significantly higher baseline disease activity than those treated with methotrexate. The highest disease activity was found for patients treated with the combination infliximab/leflunomide. After 36 months, the discontinuation rates were 46.3%, 51.3% and 61.5% for combinations of etanercept, adalimumab and infliximab with methotrexate and 53.4%, 63.1% and 67.1% for combinations with leflunomide, respectively. European League Against Rheumatism response rates after 24 months ranged from 74% to 81% for combinations with methotrexate and 72% to 81% for combinations with leflunomide.
CONCLUSION: The current clinical practice is to use methotrexate as a first choice for the combination with TNFalpha antagonists. In a number of patients methotrexate has to be replaced by another disease-modifying antirheumatic drug. Our data support the view that leflunomide is a useful alternative if methotrexate is contraindicated.
A Strangfeld; F Hierse; J Kekow; U von Hinueber; H-P Tony; R Dockhorn; J Listing; A Zink
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-01-06
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  68     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-13     Completed Date:  2009-12-31     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  1856-62     Citation Subset:  IM    
German Rheumatism Research Centre, Epidemiology Unit, 10117 Berlin, Germany.
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MeSH Terms
Antibodies, Monoclonal / adverse effects,  therapeutic use
Antibodies, Monoclonal, Humanized
Antirheumatic Agents / adverse effects,  therapeutic use*
Arthritis, Rheumatoid / drug therapy*
Drug Therapy, Combination
Epidemiologic Methods
Immunoglobulin G / adverse effects,  therapeutic use
Immunosuppressive Agents / adverse effects,  therapeutic use
Isoxazoles / adverse effects,  therapeutic use*
Methotrexate / adverse effects,  therapeutic use*
Middle Aged
Product Surveillance, Postmarketing / methods
Receptors, Tumor Necrosis Factor / therapeutic use
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Young Adult
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Antirheumatic Agents; 0/Immunoglobulin G; 0/Immunosuppressive Agents; 0/Isoxazoles; 0/Receptors, Tumor Necrosis Factor; 0/Tumor Necrosis Factor-alpha; 0/infliximab; 185243-69-0/TNFR-Fc fusion protein; 59-05-2/Methotrexate; 75706-12-6/leflunomide; FYS6T7F842/adalimumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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