Combination of Enbrel and Methotrexate More Effective Than Enbrel Alone
by Dr. David Borenstein, updated by C.H. Weaver 1/2020
Among patients with rheumatoid arthritis (RA) who have received six months of treatment with a combination of Enbrel (etanercept) and methotrexate, continuing treatment with both drugs was more effective overall than continuing treatment only with Enbrel. These results were published in Annals of the Rheumatic Diseases.
Enbrel is a type of biologic disease-modifying anti-rheumatic drug (DMARD) known as a TNF inhibitor. TNF is a protein that contributes to the inflammation of RA and several other conditions, and Enbrel reduces the level of active TNF in the body.
To determine whether Enbrel alone is as effective as Enbrel plus methotrexate among patients who have already been treated with a combination of the two drugs, researchers conducted a clinical trial among 205 RA patients who had completed six months of treatment with Enbrel plus methotrexate. Half the patients continued to receive treatment with Enbrel plus methotrexate and half the patients discontinued methotrexate and received treatment with Enbrel alone.
- RA disease activity (assessed by the DAS28 score) remained stable in patients who were treated with Enbrel plus methotrexate, and increased slightly in patients who were treated with Enbrel alone.
- In the subset of patients who had low disease activity (DAS28<3.2) after the initial six months of treatment with Enbrel plus methotrexate, continuing treatment with Enbrel alone appeared to be as effective as continuing treatment with Enbrel plus methotrexate.
These results suggest that among RA patients who have completed six months of treatment with Enbrel plus methotrexate, ongoing treatment with both drugs is more effective than treatment with Enbrel alone. Ongoing combination treatment appears to be particularly important for patients who still have moderate or high RA disease activity; patients with low disease activity after a period of combination treatment may be able to discontinue methotrexate for some time without loss of treatment efficacy.
Pope JE, Haraoui B, Thorne JC et al. The Canadian Methotrexate and Etanercept Outcome Study: a randomised trial of discontinuing versus continuing methotrexate after 6 months of etanercept and methotrexate therapy in rheumatoid arthritis. Annals of the Rheumatic Diseases. Early online publication August 26, 2013.