Comparison of effects of etanercept and methotrexate on sleep quality, fatigue and immune parameters in rheumatoid arthritis.
Etanercept is known to be the soluble tumor necrosis factor (TNF) receptor fusion protein that binds and inactivates TNF, a proinflammatory cytokine which is overproduced in the joints of patients with rheumatoid arthritis. Methotrexate has been widely used over the past decade as it decelerates the advancement of joint destruction.
Recently, a study was conducted by the group of researchers to compare the sleep quality, disease activity and patient-reported outcomes such as fatigue and immune parameters in patients with rheumatoid arthritis treated with etanercept (ETA) or methotrexate (MTX).
This was a 16-week open, prospective study comprising 36 patients having 28-joint Disease Activity Score of ≥3.2. 19 (11 women) received MTX 12.5–17 mg/w, and 17 (14 women) received ETA 25 mg x 2/w, alone or in combination with MTX. Clinical (DAS28CRP, visual analogue scale), laboratory (C-reactive protein [CRP]), sleep (polysomnography), functional (Multidimensional Fatigue Inventory; Health Assessment Questionnaire-Disability Index (HAQ-DI); 36-item Short-Form Health Survey (SF-36), immunological (humoral/cellular) and neuroendocrine (hormonal) parameters were assessed at baseline (BL), w8 and w16.
There was no significant difference between the characteristics of ETA and MTX groups apart from the disease duration: mean age (years): 48.6±8.8 vs. 49.4±16.6; mean disease duration (months): 19.6±46.3 vs. 81.2±79.2; and DAS28CRP: 4.4±0.9 vs. 4.4±1.7. Considerable improvement was seen in DAS28CRP, SF-36, and HAQ-DI in both groups from BL to w16 (p≤0.05). The DAS28CRP improvements at w16 (mean changes -1.8 in the ETA group, and -1.4 in MTX group), were not statistically considerable from each other. The was a substantial increase in the absolute values of sleep efficiency, total sleep time, and stage 2 sleep duration in the ETA group, but no noteworthy changes were reported in the MTX group.
The study postulates that both the therapies are effective in improving disease activity, CRP, SF-36 and HAQ-DI, but considerable faster and marked changes in DAS28CRP were seen with etanercept administration.