Adalimumab May Be Effective When Infliximab Fails

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NEW YORK (Reuters Health) Feb 09 - Adalimumab may be effective for

rheumatoid arthritis patients who do not respond to or cannot tolerate

infliximab, according to a report in the February ls of the Rheumatic

Diseases.

" Although etanercept and adalimumab are different molecules, with different

mode of function, however, both are efficacious when switching from

infliximab, " Dr. andros A. Drosos from University of Ioannina, Greece

told Reuters Health.

Dr. Drosos and colleagues investigated the safety and effectiveness of

adalimumab in patients with rheumatoid arthritis who had previously

discontinued therapy with infliximab because of lack of efficacy (9

patients) or adverse drug reactions (16 patients).

Twelve months of therapy with adalimumab brought significant reductions in

tender and swollen joint counts and improvements in pain score, patient

global assessment, and physician global assessment, the authors report.

These patients fared as well as patients who were able to continue receiving

infliximab.

Eight of 18 adalimumab patients who achieved an ACR 20% response had

previously discontinued infliximab treatment due to lack of efficacy, the

researchers note, whereas 10 stopped infliximab because of adverse effects.

An equal proportion of adalimumab patients and infliximab (control) patients

experienced adverse drug reactions, the report indicates, most of which

resolved without sequelae.

Two adalimumab patients discontinued treatment because of lack of efficacy,

the results indicate, compared with one infliximab patient.

" The reasons for the lack of efficacy or response to treatment of

anti-TNF-alpha antagonists are of great interest, " Dr. Drosos said. " There

are several polymorphisms in the TNF-alpha gene, and the relationship

between this and the clinical manifestations of rheumatoid arthritis and

response to therapy is under investigation by our group. "

" TNF-alpha antagonists are among the most effective therapies for rheumatoid

arthritis and other inflammatory arthropathies, " Dr. Drosos concluded.

" Physicians should recognize early and treat promptly with disease modifying

anti-rheumatic drugs - for example methotrexate + small doses of prednisone

(7.5 mg/day). In case this treatment does not give a good response, then

they should add anti-TNF therapy. "

*Ann Rheum Dis* 2006;65:257-260.