etanercept (Qiangke)

Drug Retention of First-Line Biologic Therapies in Rheumatoid Arthritis: Real-World Evidence From a Moroccan Cohort.

El Kacem El Marbouh EM, Majjad Abderrahim A, Belhadj Wissal W, Toufik Hamza H et al.

Drug retention is a meaningful real-world composite endpoint reflecting both long-term effectiveness and tolerability of biologic therapies in rheumatoid arthritis (RA). Data from North African cohorts remain scarce, and sociocultural determinants of treatment persistence are poorly explored. We conducted a retrospective observational study including RA patients who initiated first-line biologic therapy at a Moroccan tertiary center. Drug retention was defined as the time from initiation to permanent discontinuation for any reason. To compare drug retention across biologic agents, the Kaplan-Meier method was applied alongside the log-rank test. Cox proportional hazards regression was subsequently used to determine baseline factors independently associated with treatment discontinuation. One hundred and thirty patients met the inclusion criteria, with a clear female predominance (n = 112, 86.2%) and a mean age of 58.7 ± 12.9 years. Rituximab was the most frequently prescribed first-line biologic (n = 72, 56.1%), followed by Etanercept and Tocilizumab (n = 21, 16.2% each). Drug retention differed significantly across biologics (log-rank p = 0.018). Taking Adalimumab as the reference, three biologics showed significantly better retention: Etanercept (hazard ratio (HR) = 0.14, p = 0.001), Rituximab (HR = 0.26, p = 0.006), and Tocilizumab (HR = 0.07, p < 0.001). Additional independent predictors of better retention included concomitant conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy (HR = 0.39, p = 0.014), lower baseline Simplified Disease Activity Index (SDAI) (HR = 0.96, p = 0.020), and primary education level (HR = 0.32, p = 0.033). In this real-world Moroccan cohort, non-TNF (tumor necrosis factor) biologics demonstrated favorable retention compared to Adalimumab. Beyond treatment type, both clinical and sociocultural factors were associated with persistence. Given the retrospective observational design and the inherent risk of channeling bias, these results should be interpreted with appropriate caution.

Antidrug Antibodies and Serum Etanercept Levels in Rheumatoid Arthritis: A Narrative Review.

Abdulla Anfal A AA, Younis Ali A AA, Aladul Mohammed I MI

Etanercept is a tumor necrosis factor inhibitor used widely for rheumatoid arthritis. Because patients respond differently, clinicians have increasingly explored whether measuring drug levels and antidrug antibodies could help guide treatment. This review brings together what is currently known about etanercept immunogenicity, serum concentrations, and the role of therapeutic drug monitoring, with a particular focus on practice in resource-limited settings such as Iraq. Major databases were searched (January 2010-June 2025) for clinical trials, observational studies, and systematic reviews of adults with rheumatoid arthritis receiving originator or biosimilar etanercept that reported antidrug antibodies, serum levels, or outcomes related to monitoring. Across randomized and real-world studies, etanercept generally showed low immunogenicity, with reported antidrug antibodies mostly below 15% and neutralizing antibodies rarely detected. Serum levels varied considerably between patients, and no robust therapeutic range could be defined. In most studies, etanercept concentrations did not consistently predict clinical response, and originator and biosimilar products appeared similar in terms of effectiveness and safety. Overall, these findings suggest that immunogenicity is not a major reason for etanercept treatment failure and that routine therapeutic drug monitoring is unlikely to help most patients. However, the evidence is heterogeneous, and real-world data from low- and middleincome countries, including Iraq, are still limited. Current evidence supports etanercept and its biosimilars as low-immunogenic options for rheumatoid arthritis, where routine monitoring is usually unnecessary. A more practical strategy may be to reserve targeted testing for selected non-responders while strengthening pharmacovigilance and local real-world research.

Vancomycin-induced linear IgA bullous dermatosis mimicking Stevens-Johnson syndrome/toxic epidermal necrolysis treated with etanercept.

Alanazi Rawan R, Aldahash Rawan R, Alanazi Shada Khalid SK, Almasoud Sharifah Hussain SH et al.

TB risk during treatment with biological agents and Janus kinase inhibitors: an umbrella review.

Alves R F RF, Hilário C C, Ferreira N B NB, Cascais M M et al.

BACKGROUNDBiological therapies and Janus kinase (JAK) inhibitors have revolutionised the management of immune-mediated and oncologic diseases, but concerns remain regarding their potential to increase TB risk.OBJECTIVETo systematically synthesise evidence from previous systematic reviews on the risk of TB disease associated with different biological classes and JAK inhibitors.METHODSFollowing Preferred Reporting Items for Overviews of Reviews guidelines, we conducted an umbrella review of systematic reviews and meta-analyses, registered in PROSPERO (CRD42024497515). Twenty-five reviews met the inclusion criteria. Data were extracted on TB incidence, risk estimates, type, and time to onset. Risk of bias was assessed using ROBIS.RESULTSAnti-TNF monoclonal antibodies (infliximab, adalimumab) were consistently associated with the highest TB risk (odds ratio commonly 3-5), with greater proportions of disseminated/extra-pulmonary disease compared to etanercept. Combination immunosuppression further increased risk. IL-6, IL-17, and IL-23 inhibitors showed low TB reactivation rates under screening and prophylaxis protocols. JAK inhibitors (notably tofacitinib) conferred geographically variable risk, higher in intermediate/high-burden countries. Immune checkpoint inhibitors, especially PD-1/PD-L1 agents, were linked to TB incidence far above background rates.CONCLUSIONTB risk varies markedly across biologic and targeted agents. Risk-based TB infection screening and tailored prophylaxis beyond anti-TNF therapy are warranted, particularly in endemic regions..