Implications for Decision Making;
: IFX and ETN are moderately effective at one year. Evidence suggests that IFX and ETN, used concomitantly with MTX, improve surrogate and composite outcomes, such as delay in radiological progression and American College of Rheumatology improvement criteria. The long-term impact on functionality, survival, or quality of life has not been demonstrated.
: Concerns remain regarding long-term harm. Evidence suggests that risks for some serious complications, such as tuberculosis and autoimmune disorders, are greater with IFX than with ETN. Half of patients receiving IFX and a third of patients receiving ETN discontinued therapy by the third year of treatment. Patients receiving therapy should be monitored.
: IFX and ETN are not cost-saving. Economic evidence suggests that ETN and IFX, when used concomitantly with MTX, is only costeffective for the treatment of RA after the failure of other DMARDs, and if society is willing to pay >100,000 Canadian dollars to obtain a quality adjusted life-year.