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Effect of etanercept on serum amyloid A protein (SAA) levels in patients with AA amyloidosis complicating inflammatory arthritis
Clinical Rheumatology, 05/02/08

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.

• 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

• 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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