Sustained remission with methotrexate monotherapy after 22-week induction treatment with TNF-alpha inhibitor and methotrexate in early psoriatic arthritis: an open-label extension of a randomized placebo-controlled trial.

Autor: de Jong HMY; Department of Clinical Immunology and Rheumatology, Infection & Immunity Institute, Amsterdam UMC, AMC/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.; Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, the Netherlands., van Mens LJJ; Department of Clinical Immunology and Rheumatology, Infection & Immunity Institute, Amsterdam UMC, AMC/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.; Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, the Netherlands., Nurmohamed MT; Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, the Netherlands.; Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Department of Rheumatology, Reade, Amsterdam, the Netherlands., Kok MR; Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, the Netherlands., van Kuijk AWR; Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, the Netherlands.; Department of Rheumatology, Reade, Amsterdam, the Netherlands., Baeten DLP; Department of Clinical Immunology and Rheumatology, Infection & Immunity Institute, Amsterdam UMC, AMC/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.; Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, the Netherlands., van de Sande MGH; Department of Clinical Immunology and Rheumatology, Infection & Immunity Institute, Amsterdam UMC, AMC/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. m.g.vandesande@amc.uva.nl.; Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, the Netherlands. m.g.vandesande@amc.uva.nl.
Jazyk: angličtina
Zdroj: Arthritis research & therapy [Arthritis Res Ther] 2019 Sep 14; Vol. 21 (1), pp. 208. Date of Electronic Publication: 2019 Sep 14.
DOI: 10.1186/s13075-019-1998-4
Abstrakt: Background: If TNF inhibitors are initiated in the early stages of psoriatic arthritis, this could potentially modulate disease and therefore allow us to discontinue the TNF inhibitor after achieving remission.
Objective: To investigate whether remission induced by tumour necrosis factor alpha inhibitor (TNFi) and methotrexate in patients with early psoriatic arthritis is sustained after withdrawal of TNFi.
Methods: Open-label extension of a recently published double-blind, randomized placebo-controlled trial. Patients with psoriatic arthritis fulfilling the CASPAR criteria and with active disease at baseline (swollen and tender joint count ≥ 3) were randomized to either golimumab and methotrexate or matched placebo and methotrexate. Patients in Disease Activity Score (DAS) remission at week 22 continued in the open-label extension on methotrexate monotherapy. The primary end point was the percentage of patients in DAS-CRP remission (DAS < 1.6) at week 50.
Results: Eight patients from the original placebo group and 18 patients from the original TNFi group continued in the extension phase. At week 50, 6 out of 8 (75%) patients from the original MTX (methotrexate) group versus 10 out of 18 (56%) patients from the original MTX+TNFi group were in DAS-CRP remission (p = 0.347). Considering the total study population, 6 out of 24 (25%) of the original MTX group versus 10 out of 26 (38.5%) of the original MTX+TNFi group were in DAS remission at week 50 (p = 0.308).
Conclusions: Remission achieved by initial combination treatment with TNFi and methotrexate in early psoriatic arthritis is maintained on methotrexate monotherapy in approximately half of the patients.
Trial Registration: Registered at Clinicaltrials.gov with number NCT01871649 on June 7, 2013.
Databáze: MEDLINE
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