Secondary addition of methotrexate to partial responders to etanercept alone is effective in severe rheumatoid arthritis.

Etanercept, a soluble tumour necrosis factor α (TNFα) receptor fusion protein, may be combined with methotrexate (MTX) in severe rheumatoid arthritis (RA).1 Etanercept is generally given to patients treated with MTX who have an inadequate response. However, MTX could be introduced to patients who have already been treated with etanercept and who initially had a good response but subsequently a secondary failure. It was decided to evaluate, in an open prospective study, the clinical, biological, and functional benefit of the secondary addition of MTX in patients with RA with an inadequate response to etanercept alone. A cohort of 93 patients with active and severe RA was observed for a mean duration of 8 months (range 1–20). The group comprised 75 women, 18 men, with an average age of 49.5 years (range 17–75), and positive rheumatoid factor …