Does route of administration affect the outcome of TNF antagonist therapy.docVIP

Available online /content/6/S2/S19 Review Does route of administration affect the outcome of TNF antagonist therapy? Sergio Schwartzman1 and G James Morgan Jr2 1Hospital for Special Surgery, New York, NY, USA 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Corresponding author: Sergio Schwartzman (e-mail: schwartzmans@) Received: 17 Jul 2003 Accepted: 6 Aug 2003 Published: 21 Jun 2004 Arthritis Res Ther 2004, 6(Suppl 2):S19-S23 (DOI 10.1186/ar996) ? 2004 BioMed Central Ltd (Print ISSN 1478-6354; Online ISSN 1478-6362) Abstract The tumor necrosis factor (TNF) antagonists are parenterally administered biologic response modifiers indicated for the management of rheumatoid arthritis. Although infliximab, etanercept, and adalimumab are all members of this class, they differ in route of administration and dosing regimen. In the USA and in Europe, infliximab, in combination with oral methotrexate, is administered intravenously, initially at a dose of 3mg/kg at weeks 0, 2, and 6, then every 8 weeks thereafter. The US Food and Drug Administration (FDA) has further approved that the dosage can be increased to 10mg/kg and the doses can be given as often as every 4 weeks to optimize patient outcome (information based on the US package insert dated June 2002). Etanercept and adalimumab are given subcutaneously and can be self-injected. The FDA-approved dose of etanercept is 25mg twice weekly, and of adalimumab is 40mg every 2 weeks with methotrexate, or 40mg alone. Medication adherence, possibly the most important factor in maintaining the benefits of anti-TNF therapy, is influenced by the interaction between the patient and his or her healthcare team, the patient’s attitude toward the disease and medication regimen, and the choice of therapy. Keywords: adherence, efficacy, intravenous, rheumatoid arthritis, subcutaneous, tumor necrosis factor Introduction 8 weeks thereafter. In select patients, the