This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

The objectives of this report were to review the available data on the treatment of Rheumatoid Arthritis (RA) with etanercept (ETN; Enbrel) and infliximab (IFX; Remicade) with respect to the timing of therapeutic introduction, dose escalation, and switching between IFX and ETN.

Implications for Decision Making;

: Anti-TNF therapy is mostly beneficial in patients who have failed other therapies. The evidence suggests that the benefits of IFX or ETN combined with methotrexate (MTX), compared to using MTX alone, are increased in patients with longer disease duration (DD) or who had failed previous treatment with MTX.

: Uncertainty remains regarding dose escalation. Increased doses of IFX are common in clinical practice, but the design of identified studies is inadequate to evaluate the clinical benefits or potential risks of this dose escalation.

: There is no definitive evidence for switching. The studies that were identified suggested patients can respond after switching from one agent to another, but did not allow for definitive conclusions to be drawn about the overall effectiveness of this practice.

: The optimal sequence has not been established. Limitations in evidence did not permit a sequence analysis to determine an ideal order for prescribing therapies.