The goals of RA treatment can be achieved within a year of combined therapy with Wyeth’s Enbrel and the standard methotrexate in patients with severe disease who are treated early and these effects can be maintained, new findings show.

The COMET study, published last year in The Lancet, tested the effects of combined therapy with Enbrel (etanercept)/methotrexate against methotrexate alone to see if earlier, more aggressive treatment had an impact on outcomes compared with standard monotherapy.

Rheumatologists aim for clinical remission, control of inflammation, and to stop the progression of joint damage. First-year results from COMET showed that the combination of Enbrel with methotrexate improved the proportion - significantly - of patients who achieved clinical remission and radiographic non-progression compared to MTX monotherapy. Now, two-year results presented at the EULAR conference in Copenhagen show that this benefit was maintained.

Presenting the results Professor Paul Emery, lead COMET investigator and Professor of Rheumatology at the University of Leeds, said: “The major finding of this study is that the combination of etanercept and methotrexate produces a high rate of remission that is sustained over two years without significant additional risk.”

The study also looked at the impact of delaying combination therapy. Subjects originally randomised to methotrexate monotherapy in the first year of the study were then randomised to continue with this or switch to the combination of etanercept and methotrexate. “Although delayed combination therapy was significantly more effective than methotrexate monotherapy with regard to clinical remission, it was not more effective in inhibiting progression of joint damage," Professor Emery commented. The message from this study, he added, is that while inflammation can be brought in line with delayed combination treatment, "structural damage can never recover.”

By Rhonda Siddall