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Law-Wan J, Sparfel MA, Derolez S, Azzopardi N, Goupille P, Detert J, Mulleman D, Bejan-Angoulvant T. Predictors of response to TNF inhibitors in rheumatoid arthritis: an individual patient data pooled analysis of randomised controlled trials. RMD Open 2021; 7:rmdopen-2021-001882. [PMID: 34789535 PMCID: PMC8601061 DOI: 10.1136/rmdopen-2021-001882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To identify patient characteristics associated with responsiveness to tumour necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA). Materials and methods Individual patient data from 29 randomised controlled trials (RCTs) evaluating the efficacy of a TNFi versus placebo or conventional therapy were obtained. Response to treatment was assessed in subgroups according to the following baseline characteristics: smoking status, physical activity, sex, age, body mass index, autoantibody profile, disease duration, high initial disease activity defined by Disease Activity Score on 28 joints (DAS28)(C reactive protein (CRP)) >5.1. The primary outcome was the between-treatment group difference in DAS28(CRP) change from baseline to 6 months. The secondary endpoints were the between-treatment group difference in final DAS28(CRP) measured until 6 months and EULAR response criteria until 6 months. Data from each RCT were then pooled by the Mantel-Haenszel method using a random effects model. A linear metaregression was also carried out on two data-sharing platforms separately to support the results. Results Individual data of 11 617 patients from 29 RCTs were analysed. Until 6 months, a significantly higher EULAR non-response rate was observed in obese patients (OR 0.52 vs 0.36 for non-obese, p=0.01). A multivariable regression model performed on 7457 patients indicated that patients treated by TNFi had a final DAS28(CRP) decreased by 0.02 for each year of disease duration (p<0.001), and a 0.21 decreased for patients with a baseline DAS28(CRP) >5.1 (p<0.001). Conclusions In RA, patients who are more responsive to TNFi are those who are non-obese, have a long disease duration and have a high initial disease activity.
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Affiliation(s)
- Johan Law-Wan
- Department of Rheumatology, CHRU de Tours, Tours, France.,EA 7501 GICC, Université de Tours, Tours, France
| | - Marc-Antoine Sparfel
- Department of Rheumatology, CHRU de Tours, Tours, France.,EA 7501 GICC, Université de Tours, Tours, France
| | - Sophie Derolez
- Department of Rheumatology, CHRU de Tours, Tours, France.,EA 7501 GICC, Université de Tours, Tours, France
| | - Nicolas Azzopardi
- EA 7501 GICC, Université de Tours, Tours, France.,ERL 7001, CNRS, Tours, France
| | - Philippe Goupille
- Department of Rheumatology, CHRU de Tours, Tours, France.,EA 7501 GICC, Université de Tours, Tours, France
| | - Jacqueline Detert
- Medical Practice of Rheumatology and Clinical Immunology, Rheumatologisch-immunologische Praxis, Templin, Germany
| | - Denis Mulleman
- Department of Rheumatology, CHRU de Tours, Tours, France .,EA 7501 GICC, Université de Tours, Tours, France
| | - Theodora Bejan-Angoulvant
- Department of Clinical Pharmacology, CHRU de Tours, Tours, France.,EA 4245 T2I, Université de Tours, Tours, France
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Pappas DA, Shan Y, Lesperance T, Kricorian G, Karis E, Rebello S, Hua W, Accortt NA, Stryker S. Maintenance of Sustained Low Disease Activity or Remission in Patients With Rheumatoid Arthritis Treated With Etanercept Monotherapy: Results from the Corrona Registry. ACR Open Rheumatol 2020; 2:588-594. [PMID: 32990361 PMCID: PMC7571397 DOI: 10.1002/acr2.11168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/27/2020] [Indexed: 11/20/2022] Open
Abstract
Objective The purpose of this study was to evaluate maintenance of remission/low disease activity (LDA) in patients with rheumatoid arthritis (RA) who achieved remission/LDA with etanercept (ETN) plus a conventional synthetic disease‐modifying antirheumatic drug (csDMARD) and to compare patients who discontinued csDMARD to receive ETN monotherapy (Mono) with those remaining on combination therapy (Combo). Methods Patients from the Corrona RA registry between October 1, 2001, and August 31, 2017, were eligible. The index date for the Mono cohort was the csDMARD discontinuation date; the index visit for the Combo cohort was estimated from time between ETN initiation and csDMARD discontinuation in the Mono cohort. The main outcome calculated was maintenance of remission/LDA. Patients were censored if they switched to or added a biologic DMARD, discontinued ETN, when a csDMARD was reintroduced (Mono), or if methotrexate increased more than 5 mg/d (Combo). Trimming was used to balance demographic and clinical characteristics between groups. Cox regression models were adjusted for the remaining differences across groups. Results We identified 182 Mono and 403 Combo patients; 120 Mono and 207 Combo patients remained after trimming. Most patients (approximately 80%) were biologic medication–naive before initiating ETN. At 24 months postindex, modeled percentages of patients remaining in remission/LDA were 75% for Mono and 86% for Combo (overall adjusted P = 0.057). More patients were censored for therapy change in Mono than in Combo groups (37% versus 5%), largely due to reintroduction of csDMARDs in the Mono group. Conclusion Many patients with RA who achieved remission/LDA on combination therapy maintained remission/LDA with ETN monotherapy for 2 years after csDMARD discontinuation. ETN monotherapy may be a viable option for patients who discontinue csDMARDs after achieving LDA/remission.
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Affiliation(s)
- Dimitrios A Pappas
- Corrona, LLC, Waltham, Massachusetts, and Columbia University College of Physicians and Surgeons, New York, New York
| | - Ying Shan
- Corrona, LLC, Waltham, Massachusetts
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Real-world experience of tocilizumab in rheumatoid arthritis: sub-analysis of data from the Italian biologics’ register GISEA. Clin Rheumatol 2017; 37:315-321. [DOI: 10.1007/s10067-017-3846-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/31/2017] [Accepted: 09/18/2017] [Indexed: 12/28/2022]
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Narongroeknawin P, Chevaisrakul P, Kasitanon N, Kitumnuaypong T, Mahakkanukrauh A, Siripaitoon B, Katchamart W. Drug survival and reasons for discontinuation of the first biological disease modifying antirheumatic drugs in Thai patients with rheumatoid arthritis: Analysis from the Thai Rheumatic Disease Prior Authorization registry. Int J Rheum Dis 2016; 21:170-178. [DOI: 10.1111/1756-185x.12937] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pongthorn Narongroeknawin
- Division of Rheumatology; Department of Medicine; Phramongkutklao Hospital and Phramongkutklao College of Medicine; Bangkok Thailand
| | - Parawee Chevaisrakul
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Tasanee Kitumnuaypong
- Rheumatology Unit; Department of Internal Medicine; Rajavithi Hospital; Bangkok Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Boonjing Siripaitoon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology; Department of Medicine; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
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5
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Rintelen B, Zwerina J, Herold M, Singer F, Hitzelhammer J, Halder W, Eichbauer-Sturm G, Puchner R, Stetter M, Leeb BF. Validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology: current practice of bDMARD therapy in rheumatoid arthritis in Austria. BMC Musculoskelet Disord 2016; 17:358. [PMID: 27550175 PMCID: PMC4994324 DOI: 10.1186/s12891-016-1207-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022] Open
Abstract
Background The purpose of the present study was to check the validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology, and to elucidate eventual differences with respect to disease activity (DA) in patients with rheumatoid arthritis (RA) on established biological DMARDs (bDMARDs) before inclusion into the register (EST) and beginners at the time point of inclusion (NEW) after 1 year of treatment. Methods RA patients with a complete follow-up of 1 year in BIOREG were divided into EST and NEW and compared with respect to DA, remission rates, concomitant synthetic DMARDs (csDMARDs) and glucocorticoid therapy (GC) at baseline and after 1-year follow-up. Safety concerns are listed. Descriptive statistics are applied. Results For 346 RA patients (284 EST, 62 NEW) out of 970 RA patients included into BIOREG, a full data set for a 1-year follow-up was available. No differences in DA were observed after 1 year as expressed by DAS28 or RADAI-5, and small differences as expressed by remission rates according to DAS28, RADAI-5 or Boolean criteria (namely approximately 1/2, 1/3 to 1/4 and 1/4 to 1/5 of the patients respectively). Sixty-four adverse events (AEs) were noted in 56 (20 %) of EST and 20 in 19 (31 %) of NEW patients. Malignancy occurred in four patients. After 1 year, 48 % of EST patients but only 16 % of NEW patients were on bDMARD monotherapy. Conclusion Regarding DA, the date collected in BIOREG appeared to be valid. After 1 year of bDMARD therapy, all patients, whether EST or NEW, achieved a similar level of DA. AEs occurred more frequently during the early phase of bDMARD treatment. Austrian rheumatologists initiate bDMARD therapy in patients with lower disease levels than in other European countries, leading to high remission rates.
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Affiliation(s)
- Bernhard Rintelen
- Lower Austrian State Hospital Stockerau, 2nd Department for internal medicine, Lower Austrian Center for Rheumatology, Landstrasse 18, Stockerau, 2000, Austria. .,Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, Stockerau, 2000, Austria.
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Heinrich-Collinstrasse 30, Vienna, 1140, Austria
| | - Manfred Herold
- Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Franz Singer
- BIOREG, Schloßhoferstrasse 4/4/12, Vienna, 1221, Austria
| | - Johann Hitzelhammer
- Health Center Vienna Mariahilf, Wiener Gebietskrankenkasse, Mariahilfer Strasse 85-87, Vienna, 1060, Austria
| | | | | | - Rudolf Puchner
- Office based rheumatologist, Freiung 19, Wels, 4070, Austria
| | - Miriam Stetter
- Department for Internal Medicine, Lower Austrian State Hospital Amstetten, Krankenhausstrasse 21, Amstetten, 3300, Austria
| | - Burkhard F Leeb
- Lower Austrian State Hospital Stockerau, 2nd Department for internal medicine, Lower Austrian Center for Rheumatology, Landstrasse 18, Stockerau, 2000, Austria.,Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, Stockerau, 2000, Austria.,Medical University of Graz, Auenbruggerplatz 2, Graz, 8010, Austria
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6
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Iannone F, Sinigaglia L, Favalli EG, Sarzi-Puttini P, Atzeni F, Caporali R, Codullo V, Ferraccioli G, Gremese E, Carletto A, Giollo A, Govoni M, Bergossi F, Galeazzi M, Cantarini L, Salaffi F, Di Carlo M, Bazzani C, Pellerito R, Sebastiani M, Ramonda R, Lapadula G. Drug survival of adalimumab in patients with rheumatoid arthritis over 10 years in the real-world settings: high rate remission together with normal function ability. Clin Rheumatol 2016; 35:2649-2656. [PMID: 27418051 DOI: 10.1007/s10067-016-3349-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 01/06/2023]
Abstract
The purpose of the study was to estimate the clinical profile of naïve biological patients with rheumatoid arthritis (RA) starting adalimumab through 3-year calendar periods and their clinical outcomes such as drug survival and global clinical disease control (GCDC). RA patients starting adalimumab as first biological drug between 2003 and 2012 were subdivided in 3-year calendar periods. Survival on therapy was estimated using the Kaplan-Meier analysis. One and 2-year clinical response was assessed by calculating percentage of patients attaining GCDC (28-joint Disease Activity Score (DAS28) ≤ 2.6 + Health Assessment Questionnaire (HAQ) ≤ 0.5), low disease activity (DAS28 ≤ 3.2), remission (DAS28 ≤ 2.6) and good European League Against Rheumatism (EULAR) response. Multivariate regression models were used to assess baseline predictors of drug discontinuation or achievement of clinical remission. We recruited 1695 RA patients. Overall drug persistence at 3 years was 40.6 %, while the global rate of nonswitching patients was 54.7 %. Compared to 2003-2005, initiators in more recent years had a significantly lower 3-year crude drug retention rate (log rank, p < 0.0001) and a significantly higher rate of switching to alternative biologics (log rank, p < 0.0001). No difference in adverse events or effectiveness rate among the calendar periods was found. A substantial proportion of patients (up to 27 %) achieved GCDC at 2 years, regardless of the calendar period. In real-life setting, RA patients starting adalimumab in more recent years had a higher rate of drug discontinuation not related to ineffectiveness or side effects but to switching, probably due to a wider availability of biologics. A meaningful proportion of patients attained GCDC without any difference across calendar periods.
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Affiliation(s)
- Florenzo Iannone
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.
| | | | | | | | | | | | | | | | - Elisa Gremese
- Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | - Fausto Salaffi
- Rheumatology Unit, Università Politecnica delle Marche, Jesi, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Università Politecnica delle Marche, Jesi, Italy
| | - Chiara Bazzani
- Rheumatology Unit, University of Brescia, Brescia, Italy
| | | | - Marco Sebastiani
- Rheumatology Unit, University of Modena e Reggio Emilia, Modena, Italy
| | | | - Giovanni Lapadula
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
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7
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Yamanaka H, Nagaoka S, Lee SK, Bae SC, Kasama T, Kobayashi H, Nishioka Y, Ueki Y, Seto Y, Nishinarita M, Tamura N, Kimura N, Saito K, Tomita T, Nawata Y, Suzuki S, Ishigatsubo Y, Munakata Y, Makino Y, Inoue E, Tanaka Y, Takeuchi T. Discontinuation of etanercept after achievement of sustained remission in patients with rheumatoid arthritis who initially had moderate disease activity-results from the ENCOURAGE study, a prospective, international, multicenter randomized study. Mod Rheumatol 2015; 26:651-61. [PMID: 26698929 DOI: 10.3109/14397595.2015.1123349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the efficacy and safety of etanercept (ETN) in patients with rheumatoid arthritis (RA) with moderate disease activity and the possibility to discontinue ETN after achieving remission. METHODS Multicenter, randomized, and open-label study was conducted in Japan and Korea. RA patients (disease duration <5 years) with moderate disease activity despite methotrexate (MTX) treatment were allocated to either MTX or ETN + MTX (Period 1) for 12 months. Patients who achieved sustained remission defined as DAS28 < 2.6 at both 6 and 12 months in the ETN + MTX group, were randomized to either continue or discontinue ETN for 12 months (Period 2). RESULTS A total of 222 patients were enrolled in Period 1 and clinical remission was achieved in 106/157 (67.5%) and 5/28 (17.9%) patients in the ETN + MTX and MTX groups, respectively. In Period 2, sixty-seven patients were randomized and finally 28/32 (87.5%) and 15/28 (53.6%) patients who continued or discontinued ETN maintained clinical remission. Baseline disease activity and the presence of comorbid diseases influenced the maintenance of remission after ETN discontinuation. CONCLUSIONS ETN + MTX was efficient for RA patients with moderate disease activity into remission. After achieving sustained remission, a half of the patients who discontinued ETN could maintain remission for 1 year.
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Affiliation(s)
- Hisashi Yamanaka
- a Institute of Rheumatology, Tokyo Women's Medical University , Japan
| | - Shouhei Nagaoka
- b Internal Department of Rheumatology , Yokohama Minami Kyosai Hospital , Japan
| | - Soo-Kon Lee
- c Department of Rheumatology , Yonsei University College of Medicine , Korea
| | - Sang-Cheol Bae
- d Hanyang University Hospital for Rheumatic Diseases , Korea
| | - Tsuyoshi Kasama
- e Department of Rheumatology , Showa University Hospital , Japan
| | - Hitomi Kobayashi
- f Department of Internal Medicine , Itabashi Chuo Medical Center , Japan
| | - Yuichi Nishioka
- g Department of Rheumatism , Nishioka Clinic for Rheumatic Diseases and Allergic Diseases , Japan
| | - Yukitaka Ueki
- h Rheumatic Diseases Center , Sasebo Chuo Hospital , Japan
| | - Yohei Seto
- a Institute of Rheumatology, Tokyo Women's Medical University , Japan
| | - Makoto Nishinarita
- i Department of Internal Medicine and Rheumatology , Nishinarita Clinic , Japan
| | - Naoto Tamura
- j Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Japan
| | - Noriko Kimura
- k Division of Rheumatology , Department of Internal Medicine Keio University School of Medicine , Japan
| | - Kazuyoshi Saito
- l The 1st Department of Internal Medicine , School of Medicine University of Occupational & Environmental Health , Japan
| | - Tetsuya Tomita
- m Department of Orthopedic Surgery , Osaka University Hospital , Japan
| | - Yasushi Nawata
- n Center for Rheumatic Diseases , Chibaken Saiseikai Narashino Hospital , Japan
| | - Sadahiro Suzuki
- o Department of Connecting Tissue Disease , Shinonoi General Hospital , Japan
| | - Yoshiaki Ishigatsubo
- p Rheumatology, Hematology, Infectious Diseases , Yokohama City University Hospital , Japan
| | | | - Yuichi Makino
- r The 2nd Department of Internal Medicine , Asahikawa Medical University Hospital , Japan , and
| | - Eisuke Inoue
- s Division of Biostatistics , National Center for Child Health and Development , Japan
| | - Yoshiya Tanaka
- l The 1st Department of Internal Medicine , School of Medicine University of Occupational & Environmental Health , Japan
| | - Tsutomu Takeuchi
- k Division of Rheumatology , Department of Internal Medicine Keio University School of Medicine , Japan
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Haugeberg G, Bøyesen P, Helgetveit K, Prøven A. Clinical and Radiographic Outcomes in Patients Diagnosed with Early Rheumatoid Arthritis in the First Years of the Biologic Treatment Era: A 10-year Prospective Observational Study. J Rheumatol 2015; 42:2279-87. [PMID: 26568592 DOI: 10.3899/jrheum.150384] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study short-term and longterm clinical and radiographic outcomes in patients with early rheumatoid arthritis (RA) in the first decade of the biologic treatment era. METHODS Patients with early RA diagnosed at a rheumatology outpatient clinic were consecutively enrolled between 1999 and 2001. Data were collected on demographic characteristics, disease activity, patient-reported outcomes, and treatments. Radiographs of hands and feet were performed at baseline and after 2, 5, and 10 years and scored according to the Sharp/van der Heijde method, yielding a modified total Sharp score (mTSS). RESULTS Mean baseline age for the 94 included patients (36 men and 58 women) was 50.4 years and symptom duration 12.3 months; 67.8% were rheumatoid factor-positive. The proportion of patients in remission and in low, moderate, and high disease activity status was at baseline 4.3%, 1.1%, 35.1%, and 59.6% and at 10 years 52.1%, 20.5%, 27.4%, and 0.0%, respectively. For the period 0-2 years, 62.8% had used prednisolone, 91.5% synthetic disease-modifying antirheumatic drug (DMARD), and 18.1% biologic DMARD, and for the period 2-10 years the numbers were 50.6%, 89.3%, and 62.7%, respectively. At baseline, 70% of the patients had erosions on radiographs. Mean annual change in mTSS was for 0-2 years 3.4, 2-5 years 1.7, and 5-10 years 1.2. CONCLUSION A large proportion of our patients with RA diagnosed and treated in the new biologic treatment era achieved a status of clinical remission or low disease activity and had only a minor increase in radiographic joint damage after the first years of followup.
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Affiliation(s)
- Glenn Haugeberg
- From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Norwegian University of Science and Technology, Trondheim; Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.G. Haugeberg, MD, PhD, consultant, Department of Rheumatology, Hospital of Southern Norway Trust, professor, Norwegian University of Science and Technology; P. Bøyesen, MD, PhD, assistant doctor, Department of Rheumatology, Diakonhjemmet Hospital; K. Helgetveit, MD, Department of Rheumatology, Martina Hansens Hospital; A. Prøven, MD, Department of Rheumatology, Martina Hansens Hospital.
| | - Pernille Bøyesen
- From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Norwegian University of Science and Technology, Trondheim; Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.G. Haugeberg, MD, PhD, consultant, Department of Rheumatology, Hospital of Southern Norway Trust, professor, Norwegian University of Science and Technology; P. Bøyesen, MD, PhD, assistant doctor, Department of Rheumatology, Diakonhjemmet Hospital; K. Helgetveit, MD, Department of Rheumatology, Martina Hansens Hospital; A. Prøven, MD, Department of Rheumatology, Martina Hansens Hospital
| | - Knut Helgetveit
- From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Norwegian University of Science and Technology, Trondheim; Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.G. Haugeberg, MD, PhD, consultant, Department of Rheumatology, Hospital of Southern Norway Trust, professor, Norwegian University of Science and Technology; P. Bøyesen, MD, PhD, assistant doctor, Department of Rheumatology, Diakonhjemmet Hospital; K. Helgetveit, MD, Department of Rheumatology, Martina Hansens Hospital; A. Prøven, MD, Department of Rheumatology, Martina Hansens Hospital
| | - Anne Prøven
- From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Norwegian University of Science and Technology, Trondheim; Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.G. Haugeberg, MD, PhD, consultant, Department of Rheumatology, Hospital of Southern Norway Trust, professor, Norwegian University of Science and Technology; P. Bøyesen, MD, PhD, assistant doctor, Department of Rheumatology, Diakonhjemmet Hospital; K. Helgetveit, MD, Department of Rheumatology, Martina Hansens Hospital; A. Prøven, MD, Department of Rheumatology, Martina Hansens Hospital
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9
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Fautrel B, Nab HW, Brault Y, Gallo G. Identifying patients with rheumatoid arthritis with moderate disease activity at risk of significant radiographic progression despite methotrexate treatment. RMD Open 2015; 1:e000018. [PMID: 26509051 PMCID: PMC4613151 DOI: 10.1136/rmdopen-2014-000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/18/2023] Open
Abstract
Objectives To determine the baseline factors predictive of significant radiographic progression (SRP) in patients with moderately active rheumatoid arthritis (RA) despite receiving methotrexate (MTX). Methods Patients from the MTX arm of the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) trial with sustained moderate RA (defined as ≥3.2 mean disease activity score in 28 joints ≤5.1 during the last 6 months of the first year) were analysed for SRP (mTSS >3.0 overall) after 2 and 3 years. Baseline predictors for SRP were identified by univariate and multivariate analyses. All variables shown to be significantly associated with SRP were categorised based on clinically relevant cut-offs and tertiles and were included in a matrix risk model. Results 228 patients were assigned MTX treatment, 210 patients were in the radiographic intention-to-treat population, and 96 of these had sustained moderate RA. SRP occurred in 25 (26%) and 33 (34%) patients after 2 and 3 years of MTX treatment, respectively. Univariate and multivariate analyses found that C reactive protein (CRP) and rheumatoid factor (RF) positivity at baseline were predictive of SRP after 2 and 3 years (p<0.05 for all). The matrix risk model showed that RF positivity and CRP levels >40 mg/L at baseline were significantly associated with SRP after 2 (p<0.05 for both; R2=0.24) and 3 years (p<0.05 for both; R2=0.22). The baseline erosion score was not found to be predictive of SRP. Conclusions Patients with sustained moderate RA despite receiving MTX treatment are at risk of SRP, with both RF positivity and high CRP levels shown to be predictive of this.
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Affiliation(s)
- B Fautrel
- UPMC-GRC 08 (EEMOIS) , Paris , France ; AP-HP, Pitie Salpetriere Hospital, Dept of Rheumatology , Paris , France
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10
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Abstract
With its approval more than 15 years ago, subcutaneous etanercept (Enbrel(®)) was the first biological disease-modifying antirheumatic drug (bDMARD) and the first tumour necrosis factor inhibitor to be approved for use in rheumatic diseases. Etanercept remains an important cost-effective treatment option in adult patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or plaque psoriasis, and in paediatric patients with juvenile idiopathic arthritis or plaque psoriasis. In all of these populations, etanercept (with or without methotrexate) effectively reduced signs and symptoms, disease activity and disability, and improved health-related quality of life, with these benefits sustained during long-term treatment. The safety profile of etanercept during short- and long-term treatment was consistent with the approved product labelling, with adverse events being of a predictable and manageable nature. The introduction of etanercept and other bDMARDs as therapeutic options for patients with autoimmune rheumatic diseases and spondyloarthropathies revolutionized disease management and these agents continue to have a central role in treatment strategies. This article reviews the extensive clinical experience with etanercept in these patient populations.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand,
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