Chances in the Tournament

It’s quite clear that we are the team to beat. We are the only team in the tournament with RAVE reviews—what a very impressive feat. Siding with another team would be like choosing cyclophosphamide over rituximab; sure, it works and may get you the “W,” but why would you choose a team that will do nothing but trouble you?

Although we are confident in our chances in the tournament, we do expect to run into some tough competition from the other non-inferiority trials. There has been lots of talk about a lupus nephritis trial that also aimed to dethrone cyclophosphamide, but with a different agent, mycophenolate. However, we are only modestly impressed, at best. After all, “The enemy of my enemy is [not always] my friend.”

Should you choose to go with another team, the ref will surely blow their whistle for a travel; naysayers tread lightly because you will watch your bracket unravel.

All authors are part of the Rheumatology Fellowship Program at Wake Forest University School of Medicine, Winston-Salem, N.C.

References

1. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol. 2021 Aug;73(8):1366–1383.
2. Cohen B. The mentor who made Dr. Anthony Fauci. The Wall Street Journal. 16 Apr 2020. https://www.wsj.com/articles/the-mentor-who-made-dr-anthony-fauci-11587040520.
3. Fauci AS, Wolff SM. Wegener’s granulomatosis: Studies in eighteen patients and a review of the literature. Medicine (Baltimore). 1973 Nov;52(6):535–561.
4. Maugh TH II. Researchers find new therapy for vasculitis. Los Angeles Times. 2010 Jul 14. https://www.latimes.com/archives/la-xpm-2010-jul-14-la-heb-vasculitis-20100714-story.html.
5. Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010 Jul 15;363(3):221–232.

Etanercept for RA

TNFα inhibitors

BY JESSE REISNER, DO, CATHERINE STRAHLE, DO, JASMINE THAI, MD, & CRISTINA HURLEY, MD

Base Article

Moreland LW, Baumgartner SW, Schiff MH, et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein. N Engl J Med. 1997 Jul;337(3):141–147.¹

Team Overview

This article describes a multi-center, randomized, double-blind, placebo-controlled trial studying the efficacy of the then-novel recombinant human tumor necrosis factor receptor p75-Fc fusion protein (TNFR:Fc, or etanercept) in patients with rheumatoid arthritis (RA) who had previously failed other conventional synthetic disease-modifying antirheumatic drugs.¹

Little was known about the potential efficacy of TNFR:Fc in RA before the trial. Although the role of TNFα in the pathogenesis of RA was suspected and previous trials studying human monoclonal antibodies targeting TNFα had shown benefit in RA, this was the first randomized clinical trial evaluating the use of TNFR:Fc. In fact, the authors cite the 1996 safety and dose-finding study by Moreland et al., which showed reduction in disease activity in a small number of patients with refractory RA, as the inspiration for their trial.²