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| |  BSR: Swedes Describe Their Experience With Infliximab, Etanercept And Leflunomide In Rheumatoid Arthritis By David Jack M.D. Special to DG News
EDINBURGH, SCOTLAND -- April 30, 2001 -- Infliximab, etanercept and leflunomide were all introduced in Sweden in 1999 for the treatment of rheumatoid arthritis (RA). Presenting at the annual meeting of the British Society of Rheumatology, Dr. Meliha Crnkic and colleagues from Lund University Hospital, Lund, Sweden, for the South Swedish Arthritis Treatment Group, described their initial experiences with these drugs in patients treated in clinical practice. Using a standardized clinical protocol, they monitored the effects of treatment in seven rheumatology centers in southern Sweden. Patients with active RA who did not respond to at least two DMARDs, including methotrexate, were treated with infliximab (n = 136), etanercept (n = 166), or leflunomide (n = 103). At the start of treatment, the disease duration was a mean of 14.6 years and patients had been on an average of 4.3 DMARDs; their current mean prednisolone dosage was 48.2 mg/week. All patients were monitored using a standardized protocol which included the health assessment questionnaire (HAQ), tender and swollen joint count (28-joint index), VAS-pain, VAS-global, DrGlobal (five degrees), ESR and CRP. At November 2000, the clinical responses were evaluated according to DAS28, ACR20, ACR50 and ACR70 for the three treatments. At six months follow up, the percentage of non-responders according to DAS28 was 15 percent in the etanercept group, 16 percent in the infliximab group and 44 percent in the leflunomide group, the corresponding percentage of “moderate” responders was 46 percent, 57 percent and 33 percent, while the percentage of "good" responders was 31 percent, 24 percent and 11 percent. A similar pattern was found when ACR20 and ACR50 were used. This clinical protocol provides rapid information on the response to treatment, showing that etanercept and infliximab are relatively similar in efficacy and superior to leflunomide, as far as the treatment of chronic RA is concerned. Differences in patient selection and drug tolerability may affect comparisons and the Swedish researchers are currently studying this.
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