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Rheumatology Advance Access originally published online on May 15, 2007
Rheumatology 2007 46(7):1191-1199; doi:10.1093/rheumatology/kem091
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© 2007 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons 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.

Effectiveness of adalimumab for rheumatoid arthritis in patients with a history of TNF-antagonist therapy in clinical practice

S. Bombardieri, A. A. Ruiz1, P. Fardellone2, P. Geusens3, F. McKenna4, K. Unnebrink5, U. Oezer5, S. Kary5, H. Kupper5, G. R. Burmester6 on behalf of the Research in Active Rheumatoid Arthritis (ReAct) Study Group

Department of Internal Medicine, University of Pisa, Pisa, Italy, 1Hospital de Cruces, Bilbao, Spain, 2CHU d’Amiens, Hôpital Nord, Amiens, France, 3University Hasselt, Diepenbeek, Belgium and University Hospital, Maastricht, The Netherlands, 4Trafford General Hospital, Manchester, UK, 5Abbott GmbH & Co. KG, Ludwigshafen and 6Charité - University Medicine, Berlin, Germany.

Correspondence to: S. Bombardieri, Department of Internal Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy. E-mail: s.bombardieri{at}int.med.unipi.it


  Abstract

Objective. To evaluate the effectiveness and safety of adalimumab in patients with rheumatoid arthritis (RA) who previously discontinued tumour necrosis factor (TNF) antagonists for any reason in clinical practice.

Methods. ReAct (Research in Active Rheumatoid Arthritis) was a large, open-label trial that enrolled adults with active RA who had previously been treated with traditional disease-modifying anti-rheumatic drugs or biological response modifiers. Patients self-administered adalimumab 40 mg subcutaneously every other week for 12 weeks and were allowed to enter an optional long-term extension phase. Measures of adalimumab effectiveness included American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) response criteria, Disease Activity Score 28 (DAS28) and the Health Assessment Questionnaire Disability Index (HAQ DI).

Results. Of 6610 patients, 899 had a history of etanercept and/or infliximab therapy; these patients experienced substantial clinical benefit from adalimumab treatment. At week 12, 60% of patients had an ACR20 and 33% had an ACR50 response; 76% had a moderate and 23% had a good EULAR response. In addition, 12% achieved a DAS28 < 2.6, indicating clinical remission, and 13% achieved a HAQ DI score <0.5. The allergic adverse event rate, regardless of relationship to adalimumab, was 6.5/100-patient-years (PYs) in previously TNF-antagonist-exposed patients and 4.3/100-PYs in TNF-antagonist–naive patients. A multiple regression analysis indicated no statistically significantly increased risk of serious infections in patients who received prior TNF antagonists compared with TNF-antagonist–naive patients.

Conclusion. In typical clinical practice, adalimumab was effective and well-tolerated in patients with RA previously treated with etanercept and/or infliximab.

KEY WORDS: Adalimumab, Etanercept, Infliximab, TNF antagonist, Rheumatoid arthritis

Submitted 29 November 2006; revised version accepted 20 March 2007.
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