Infliximab is associated with high rates of dose escalation and a larger overall cost, compared with adalimumab and etanercept in patients with rheumatoid arthritis, without any additional gains in effectiveness, according to analysis of data from 563 patients in the Veterans Affairs Rheumatoid Arthritis registry.
Of patients on etanercept, 2% underwent dose escalation, compared with 16% of patients on adalimumab and 64% of patients on infliximab. Annual costs for the first course of TNF inhibitor therapy were $13,100 for adalimumab, $13,500 for etanercept, and $16,900 for the intravenously-administered infliximab.
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Infliximab is associated with high rates of dose escalation and a larger overall cost without any gains in effectiveness.
Researchers found the duration of treatment, and persistence with the first course of agent, were similar between treatment groups, and they also saw no statistically significant differences in improvements in mean DAS28 score between the three agents.
"These data and our observations suggest that dose escalation is often associated with added costs without increased benefit," wrote Dr. Grant W. Cannon of the VA Salt Lake City Health Care System and his associates in the Aug. 15 online issue of The Journal of Rheumatology [doi:10.3899/jrheum.140164].
The study was sponsored by Immunex, makers of Enbrel (etanercept); Wyeth, partner of Immunex; and the Veterans Administration Health Services. No other conflicts of interest were declared.