Anti-TNFα therapy in a cohort of rheumatoid arthritis patients: Clinical outcomes

Objective: To assess the effectiveness of anti-TNF alpha agents by analysing the principal clinical outcomes in patients with active rheumatoid arthritis (RA). Methods: 1010 patients who received no clinical benefit from previous treatment with methotrexate and/or other DMARDs, were subsequently treated with one or more of the anti-TNF alpha agents. Results: After the first six months of anti-TNF alpha therapy, 29% of the patients showed a good and 47% a moderate European League Against Rheumatism (EULAR) response, and this positive result was maintained after two years of follow-up. Their median Disease Activity Score based on the erythrocyte sedimentation rate and the evaluation of 28 joints (DAS28) decreased from 5.94 at baseline to 4 after six months (p<0.001: Delta 1.94), and further significant responses were also observed after 12, 18 and 24 months; their median 36-month DAS28 score reflected mild disease activity. The median Health Assessment Questionnaire (HAQ) score fell from 1.34 at baseline to 1 after six months of therapy (Delta 0.34; p<0.05), and a further significant reduction was observed during the second and third year of follow up. Conclusions: Especially when combined with DMARDs, anti-TNF alpha drugs can induce a good clinical response regardless of the particular molecule used, whereas their combination with steroids does not seem to improve disease outcomes at any time during follow-up. (c) 2008 Elsevier B.V. All rights reserved.