Biologic drugs comparable for rheumatoid disease

NEW YORK (Reuters Health) - Humira (adalimumab), Remicade (infliximab), and Enbrel (etanercept) are useful rheumatoid arthritis treatments and have comparable effectiveness and safety, according to an analysis of combined data. These biologic drugs are agents designed to either block or supplement immune system chemicals called cytokines. The three drugs in the current analysis all work by blocking a cytokine called tumor necrosis factor.

"Overall, biologics are highly effective treatments for rheumatoid arthritis," lead investigator Dr. Gerald Gartlehner pointed out. "Biologics, however, also have the potential for rare but severe side effects such as serious infections or cancers."

However, another biologic drug, Kineret (anakinra), which blocks a cytokine called interleukin-1, "appears to be less effective than these three drugs," Gartlehner told Reuters Health. The findings are reported in the Journal of Rheumatology.

Gartlehner of the University of North Carolina, Chapel Hill and colleagues studied data from 17 studies involving more than 5,200 patients with rheumatoid arthritis resistant to methotrexate, the standard first-line therapy for the disease. The researchers also took into account a number of other trials evaluating efficacy and safety.

The finding that the tumor-necrosis factor blocking agents were more effective than Kineret, say the investigators, is consistent with the findings of other indirect comparisons.

Overall, the researchers conclude that the safety data were insufficient to draw firm conclusion about long-term effects of biologics.

Moreover, they note, routes of administration vary. For example, Humira, Kineret and Enbrel can be injected by the patient, whereas Remicade requires an office visit every 4 to 8 weeks for injection.

Gartlehner concluded: "Given the similar effectiveness of Humira, Enbrel, and Remicade, decisions about the choice of a biologic for a patient should also include patient convenience, costs, and insurance coverage."

SOURCE: Journal of Rheumatology, December 2006.