Objectives: Managing rheumatoid arthritis (RA) can be difficult: the disease may follow an unpredictable course, and therapies are often ineffective or toxic. Etanercept, a bioengineered fusion protein derived from the human soluble tumor necrosis factor p75 receptor, recently has been approved for use in patients with refractory RA.
Methods: Published data on clinical experience with etanercept in conjunction with case illustrations are presented.
Results: Reports from clinical trials of patients with refractory RA indicate that etanercept significantly improves measures of disease activity, including swollen and tender joint counts, morning stiffness, pain, and erythrocyte sedimentation rate, compared with placebo. In the phase 3 trial, swollen joint counts improved by 47% in patients receiving etanercept 25 mg compared with a 7% worsening in patients receiving placebo. The drug is well tolerated; injection site reaction, the most frequent adverse event, was minor and manageable. In long-term studies, etanercept remains well tolerated and effective. Our clinical experience indicates that patients with refractory RA experience dramatic symptomatic relief, along with reduced fatigue and improved quality of life. One of 18 patients discontinued treatment; the rest have remained on therapy for up to 18 months.
Conclusions: Etanercept diminishes disease activity in patients with refractory RA. Its favorable safety profile provides symptom control without major toxicity. Etanercept is an important addition to RA therapeutic agents.