Etanercept versus methotrexate for sleep quality, fatigue and immunity in active rheumatoid arthritis
When the body's immune system attacks normal joint tissues, causing inflammation to joint lining, this type of autoimmune disease is known as rheumatoid arthritis. A study has been done to distinguish the sleep quality, disease activity and patient-reported outcomes like fatigue and immune parameters in patients with rheumatoid arthritis and who were treated with etanercept (ETA) or methotrexate (MTX).
The study was comprised of total 36 patients (28-joint Disease Activity Score, DAS28CRP≥3.2). Out of these patients, 19 (11 women) obtained MTX 12.5–17 mg/w, and 17 (14 women) obtained ETA 25 mg x 2/w, alone or in combination with MTX. At the baseline (BL), w8 and w16, the 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 noted down.
No significant changes were observed in the BL characteristics between the ETA and MTX groups except 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, respectively. From the BL to w16 (p≤0.05), DAS28CRP, SF-36 and HAQ-DI upgraded significantly in both groups. At w16 (mean changes -1.8 in the ETA group, and -1.4 in MTX group), DAS28CRP improvements were not statistically significant from each other. Although no significant changes were reported in the MTX group, but absolute values of sleep efficiency, total sleep time, and stage 2 sleep duration augmented significantly in the ETA group.
It was interpreted that both the therapies improved disease activity, CRP, SF-36 and HAQ-DI, with faster, more pronounced changes in DAS28CRP in the ETA group, which alone had notable improved sleep parameters.