Anti-TNFalpha therapy in a cohort of rheumatoid arthritis patients: clinical outcomes

Autoimmun Rev. 2009 Jan;8(3):260-5. doi: 10.1016/j.autrev.2008.11.001. Epub 2008 Nov 21.


Objective: To assess the effectiveness of anti-TNFalpha 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-TNFalpha agents.

Results: After the first six months of anti-TNFalpha 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-TNFalpha 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.

Publication types

  • Clinical Trial

MeSH terms

  • Adalimumab
  • Adrenal Cortex Hormones / administration & dosage
  • Aged
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents / administration & dosage*
  • Arthritis, Rheumatoid / immunology
  • Arthritis, Rheumatoid / therapy*
  • Cohort Studies
  • Drug Interactions
  • Drug Therapy, Combination
  • Etanercept
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / administration & dosage*
  • Immunotherapy, Active*
  • Infliximab
  • Infusions, Intravenous
  • Injections, Subcutaneous
  • Italy
  • Male
  • Middle Aged
  • Receptors, Tumor Necrosis Factor / administration & dosage*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / immunology*


  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Etanercept