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Rheumatology Advance Access originally published online on May 3, 2007
Rheumatology 2007 46(7):1148-1152; doi:10.1093/rheumatology/kem074
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© 2007 The Author(s)
This is an Open Access article distributed under the terms of the Creative Common Attribution Non-Commercial License (http://creativecommons/org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Quality of life and economic impact of switching from established infliximab therapy to adalimumab in patients with rheumatoid arthritis

C. A. E. Walsh1, P. Minnock2, C. Slattery1, N. Kennedy2, F. Pang3, D. J. Veale1,2, B. Bresnihan1,2 and O. FitzGerald1,2

1Department of Rheumatology, St Vincent's University Hospital, Elm Park, Dublin, Ireland, 2Rheumatology Rehabilitation Unit, Harold's Cross, Dublin, Ireland and 3Formerly of Health Economics and Outcome Research, Abbott Laboratories Ltd., Maidenhead, United Kingdom.

Correspondence to: Dr Ceara Walsh, Department of Rheumatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. E-mail: cearawalsh{at}eircom.net


  Abstract

Objective. To evaluate the quality of life and economic impact of switching therapy from infliximab to adalimumab in patients with rheumatoid arthritis (RA).

Methods. In this open-label study, patients demonstrating a clinical response to infliximab were switched to treatment with adalimumab and followed for 16 weeks. Both generic (Health Assessment Questionnaire and Short Form 36 Physical Component Summary and Mental Component Summary) and specific (Rheumatoid Arthritis Quality of Life questionnaire) assessment instruments of physical function and of quality of life were employed. An economic analysis of treatment-related costs was also performed. Disease activity was assessed by the composite 28-joint count Disease Activity Score (DAS28). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as acute phase markers.

Results. Nineteen patients were enrolled and completed the study. No changes in functional and quality-of-life measures were observed. One-year extrapolation data showed potential reductions in costs following switching to adalimumab that could be attributed primarily to reductions in patient- and staff-related costs. Safety and tolerability were similar for both treatments. Although there was a significant reduction in DAS28 (P < 0.005) and CRP (P < 0.001) after switching to adalimumab, there were no significant changes in individual DAS28 components, including swollen and tender joint counts and ESR.

Conclusions. A switch from infliximab to adalimumab in patients with RA who have responded to infliximab is a feasible, well-tolerated treatment option, with the potential for direct and indirect economic advantages.

KEY WORDS: Adalimumab, Infliximab, Therapeutic switch, Quality of life, Economic analysis

Submitted 20 December 2006; revised version accepted 2 March 2007.
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