Perry ME et al. - Etanercept represents a useful alternative to immunosuppressant therapy such as cyclophosphamide or chlorambucil. However, further work is needed to establish whether organ damage related to AA amyloidosis is slowed by etanercept. Methods
Changes in serum amyloid A protein (SAA) levels were assessed during treatment with etanercept in AA amyloidosis complicating inflammatory arthritis
5 women and 4 men pts received etanercept
SAA levels were recorded before and after commencement of treatment
2 pts received no DMARDs between the time of diagnosis of AA amyloidosis and commencement of etanercept
Results
In 7/9 pts the median SAA level during etanercept treatment was lower than levels before anti-TNF therapy
In 5/9 pts, the median post treatment level was <11 mg/l
There were no significant changes in serum creatinine or proteinuria during periods of etanercept therapy
The etanercept was stopped in 4 pts because of acute bacterial endocarditis, psoriasiform rash, psychosis and leucopenia
In 2 of these pts alternative biologics were commenced (adalimumab or anakinra) and one was restarted on etanercept
1 patient died of cerebral haemorrhage during the study
Etanercept therapy was associated with a fall in SAA levels in 7/9 pts, 5 of whom achieved levels which might be expected to be associated with stable or regressing amyloid deposits
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