Authors' objectives:

six research questions were addressed; . What is the evidence from clinical trials or observational studies of the long-term benefit and harm from Infliximab (IFX) and Etanercept (ETN) for Rheumatoid Arthritis (RA) compared to standard care? . What is the evidence of cost-effectiveness for IFX and ETN for RA compared to standard care? . What is the clinical impact of introducing IFX or ETN as initial therapy or after failure with other drug therapies? . What is the clinical impact of using higher doses at more frequent intervals (dose creep) versus no dose change? . What is the dose-related clinical impact of using IFX or ETN at various stages of disease? . Do patients who fail treatment with one anti-TNF agent respond to therapy with a different one?

Authors' recommendations: Implications for Decision Making : IFX and ETN are moderately effective at one year. The evidence suggests that IFX and ETN, when used concomitantly with methotrexate (MTX), improve surrogate and composite outcomes, such as delay in radiological progression and American College of Rheumatology improvement criteria. The longterm impact on functionality, survival, or quality of life has not been demonstrated. : IFX and ETN are not cost-saving. The economic evidence suggests that ETN and IFX, when used concomitantly with MTX, is only cost-effective for the treatment of RA after the failure of other DMARDs and if society is willing to pay more than $100,000 Canadian dollars to obtain a quality-adjusted life-year. : Timing therapy may improve response rates. Uncertainty remains about dose escalation and switching. The evidence suggests that surrogate responses to IFX or ETN combined with MTX, when compared to using MTX alone, are increased in patients with longer disease duration or in those who had failed previous treatment with MTX. There is insufficient evidence to support switching between agents and the practice of dose escalation.

Authors' methods: Overview, Cost study

Project Status: Completed

URL for project: http://www.cadth.ca/index.php/en/hta/reports-publications/search/publication/703

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)