Reumatoid artrit (RA) är en kronisk sjukdom som drabbar kroppens leder. Sjukdomen karakteriseras av inflammerade, smärtande, svullna och stela leder. I Sverige är ungefär 0,5 % av befolkningen drabbad. Mer än hälften av de som drabbas är kvinnor och insjuknandefrekvensen är högst i 50-årsåldern. Det finns ingen behandling som botar sjukdomen. Behandlingen är istället inriktad på att förhindra eller mildra symptomen som uppstår vid RA. Patienter med RA har ett flertal behandlingsalternativ, bland annat ASA, NSAID, kortison, biologiska läkemedel och DMARDs. Biologiska läkemedel har inneburit en revolution för behandling av RA. Många patienter kan med hjälp av dessa läkemedel återfå den livskvalitet de hade innan sjukdomen bröt ut. Syftet med arbetet var att undersöka hur effektiv och säker är en kombination av metotrexat och etanercept är, jämfört med monoterapi vid behandling av reumatoid artrit. Arbetet är ett litteraturarbete där sökningar gjordes i sökbasen PubMed med sökorden ”Methotrexate rheumatoid arthritis”, ”Etanercept methotrexate”, ”Etanercept rheumatoid arthritis”. Fem studier valdes ut och utvärderades. Resultatet av studierna visar på att en kombination av läkemedlen ger en något effektivare behandling med likvärdiga biverkningar. Men med tanke på de ekonomiska aspekterna bör kombinationsbehandling endast användas vid mycket hög sjukdomsaktivitet och vid otillräcklig effekt av andra läkemedel. I framtiden bör fler studier göras för att bedöma den långsiktiga effekten av en kombination av läkemedlen. / Rheumatoid arthritis, RA, is a chronic disease affecting joints in the body. The disease is characterized by periodic inflammation causing pain, swelling and damage of joints. The patient loses quality of life. In Sweden, approximately 0.5% of the population has the diagnosis RA. More than half of those affected are women and the incidence rate is highest in the 50s. RA cannot be cured by any treatment. The symptoms of the disease are treated symptomatically with for example NSAID and ASA. Patients can also be treated by immunomodulation therapy to decrease the inflammatory activity in the body. This helps to slow down the course of illness. Methotrexate belongs to the class of cytotoxic agents and is a folic acid antagonist. The drug acts by inhibiting the enzyme dihydrofolate reductase that converts folic acid to tetrahydrofolic acid. Tetrahydrofolic acid is an important building block for the cell's inheritance. In RA a low dose MTX is used and the drug inhibits the immune system and inhibits disease progression. Etanercept is a fusion protein that is genetically produced. It consists of two identical TNFR2 extracellular regions fused to an Fc domain of human IgG1. The drug blocks / neutralizes TNFα from interacting with receptors and has enabled the development of breakthrough therapies to treat a variety of autoimmune inflammatory diseases. In RA, the proinflammatory cytokine TNF stimulates the inflammation and thereby plays a central role in the process. TNF inhibitors slow down the effect of the substance and the inflammation of the joints in the body decreases. The aim of this study was to examine how effective and safe a combination of methotrexate and etanercept is, compared to monotherapy in the treatment of RA. The searches were made in PubMed and the keywords used were “Methotrexate rheumatoid arthritis”, ”Etanercept methotrexate”, ”Etanercept rheumatoid arthritis”. Five studies were chosen. The results of the studies indicate that a combination of drugs provides a slightly more effective treatment with equivalent side effects. However, given the economic aspects, combination therapy should only be used in very high disease activity and in intolerance to other drugs. In the future, more studies should be done to assess the long-term effect of a combination of drugs.

Rheumatoid arthritis (RA) is a chronic joint disease which mechanism of action is unknown. The immune mechanism initiates an inflammatory process that mainly affects the joints, which can lead to cartilage and bone damage but also to some generalized symptoms such as fatigue and inflammatory anemia. At present, RA is primarily treated with methotrexate (MTX) as monotherapy. Studies in the field indicate that MTX in combination with infliximab, a monoclonal antibody, is more effective in treating RA than MTX treatment alone. Most likely, infliximab is not used as first-hand therapy since the reference product Remicade® is very expensive. In 2015 the patent for Remicade® expired and there are now cheaper biosimilars available that have been approved for the same indication as Remicade®. The aim of this study was to investigate whether MTX in combination with infliximab is more effective than MTX alone in the treatment of active RA and evaluating whether there is equivalence between the reference product Remicade® and the CT-P13 biosimilar. The medical and bioscience database PubMed was used to obtain the scientific articles analyzed in this literature study. From PubMed 5 articles were selected for further analysis. The delimitation of the search was: indication RA, MTX, infliximab and biosimilar (CT-P13). Articles 1-3, based on the outcome variables of the studies indicated that infliximab in combination with MTX is more effective than MTX treatment alone in the treatment of active RA. Articles 4-5 examined equivalence between the reference product for infliximab (RP) and the biosimilar CT-P13 in the treatment of active RA. The analysis and results of articles 4-5 showed that there was a similarity between RP and CT-P13 in treatment of active RA. Based on this small-scale literature study, treatment with MTX in combination with infliximab seems more beneficial for disease control in active RA than MTX treatment alone. In addition, the biosimilar CT-P13 appears to be equivalent to the reference product Remicade® in the treatment of active RA. Replacement of Remicade® to CT-P13 can mean major savings in healthcare and the therapeutic recommendation for active RA may need to be reviewed as there are now effective, cheaper alternatives.