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.