Dual Therapy for RA Delivers Superior Remission

Emery P, Hammoudeh M, FitzGerald O, et al. Sustained Remission with Etanercept Tapering in Early Rheumatoid Arthritis  New England Journal of Medicine. 2014; 371:1781-1792 doi 10.1056/NEJMoa1316133

Methotrexate plus etanercept bests methotrexate alone for maintaining rheumatoid arthritis (RA) remission, according to results of this three-phase trial.

The leaders of this 306-patient trial conducted in England and Europe suggest that reducing or even withdrawing biologic therapy is possible  for patients who have sustained remission based on accepted criteria.

They also point out that patients in remission after treatment with the combination who then continue on the dual agents at a lower dose experience better disease control than those who stay on methotrexate alone.

Patients with early active disease received methotrexate plus etanercept (50mg) for 52 weeks (phase I). Those who responded moved on to methotrexate plus etanercept (25mg), methotrexate alone, or placebo for 39 weeks (phase II).

At the end of phase II, 63% of the methotrexate plus etanercept patients were in remission, as were 40% of the methotrexate alone, and 23% of the placebo patients.

In the trial's final phase, all study drugs were stopped, and patients were followed for another 20 weeks.

Among those on methotrexate plus etanercept, 44% remained in remission versus 29% of those on methotrexate alone and 23% on placebo.

The authors note that some patients maintain remission after discontinuing both treatments.