Adalimumab (Humira®) restores clinical response in patients with secondary loss of efficacy from infliximab (Remicade®) or etanercept (Enbrel®): results from the STURE registry at Karolinska University Hospital

Abstract

Objectives: To determine whether the tumour necrosis factor‐α (TNF‐α) antagonist adalimumab (Humira®) can be efficacious after secondary loss of efficacy (i.e. loss of clinical response in patients who had initially demonstrated clinical response) to infliximab (Remicade®) or etanercept (Enbrel®).

Patients and methods: We studied 36 patients from the Stockholm TNF‐α follow‐up registry (STURE) who received adalimumab after secondary loss of efficacy to infliximab (group A, n = 27) or etanercept (group B, n = 9), and 26 patients who were started on adalimumab as the first TNF‐α antagonist (group C).

Results: In group A, the baseline disease activity score 28 (DAS28) at infliximab institution was 5.5±0.2. During infliximab treatment, the mean best DAS28 was 3.7±0.2 (p<0.001), but increased to 5.2±0.3 when infliximab was stopped. After 3 months on adalimumab, the mean DAS28 decreased to 4.5±0.3 (p<0.003), and then to 4.2±0.2 at 6 months (p<0.001). In group B, the baseline DAS28 at etanercept institution was 6.6±0.5. During etanercept treatment, the mean best DAS28 was 4.6±0.5 (p<0.01), but increased to 5.7±0.4 by the time etanercept was stopped. After 3 months on adalimumab, the mean DAS28 decreased to 4.8±0.3 (p<0.005), and to 4.1±0.2 at 6 months (p<0.001). In group C, the mean baseline DAS28 was 5.6±0.3. After 6 months of adalimumab therapy, the DAS28 decreased to 3.5±0.4 (p<0.001). ACR20 responses with adalimumab in groups A, B, and C were similar (70–78%).

Conclusions: For patients with secondary loss of efficacy from infliximab or etanercept, switching to adalimumab can restore a good clinical response.