Adalimumab, a fully human anti–tumor necrosis factor α monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: The ARMADA trial

280

167

Objective. To assess the efficacy, safety, and pharmacology of subcutaneous administration of golimumab in patients with active rheumatoid arthritis (RA) despite treatment with methotrexate (MTX).Methods. Patients were randomly assigned in a double-blinded manner to receive injections of placebo plus MTX or 50 mg or 100 mg golimumab every 2 or 4 weeks plus MTX through week 48. Patients originally assigned to receive injections every 2 weeks had the interval increased to every 4 weeks starting at week 20. The primary end point was the proportion of patients meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) at week 16. The study was powered to detect a difference in the primary end point when the combined golimumab groups and at least 1 of the individual dose groups were compared with placebo.Results. The primary end point was attained. Sixty-one percent of patients in the combined golimumab plus MTX dose groups achieved an ACR20 response at week 16 compared with 37% of patients in the placebo plus MTX group (P ‫؍‬ 0.010). In addition, 79% of patients in the group receiving 100 mg golimumab every 2 weeks achieved an ACR20 response (P < 0.001 versus placebo). Through week 20 (after which patients receiving placebo were switched to active infliximab therapy), serious adverse events were reported in 9% of patients in the combined golimumab groups and in 6% of patients in the placebo group.Conclusion. Golimumab plus MTX effectively reduces the signs and symptoms of RA and is generally well tolerated in patients with an inadequate response to MTX.

Section: Discussionmentioning

confidence: 99%

Golimumab in patients with active rheumatoid arthritis despite treatment with methotrexate: A randomized, double‐blind, placebo‐controlled, dose‐ranging study

Kay

Matteson

Dasgupta³

et al. 2008

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167

“…Therapy with TNF␣ blocking agents has resulted in remarkable improvement in RA, both in clinical and radiologic parameters (59)(60)(61). In a recent study of RA patients with active disease at baseline, those with the TNFA -308 GG genotype responded better to infliximab (3 mg/kg) than did patients with AA or AG genotypes (33); 42% of patients in the AA plus AG group versus 81% of those in the GG group had improvement of at least 1.2 in the DAS28 score (28 joints assessed) (P ϭ 0.008).…”

Section: Discussionmentioning

confidence: 99%

Association of tumor necrosis factor α polymorphism, but not the shared epitope, with increased radiographic progression in a seropositive rheumatoid arthritis inception cohort

Khanna

Park

et al. 2006

Objective. To determine whether the tumor necrosis factor ␣ (TNFA) -308 guanine-to-adenosine polymorphism and/or the shared epitope (SE) is associated with radiographic damage in patients with early rheumatoid arthritis (RA).Methods. The cohort consisted of 189 patients with early seropositive RA (median 5.6 months since symptom onset) who had active disease, no previous disease-modifying antirheumatic drug treatment, and >2 sets of scored radiographs of the hands/wrists and forefeet. TNFA -308 polymorphism was analyzed by polymerase chain reaction pyrosequencing. The SE was defined as presence of any 1 of the following HLA-DRB1 alleles: *0101, *0102, *0401, *0404, *0405, *0408, *0410, *1001, *1402, or *1406. Radiographic progression was assessed by the total Sharp score.Results. Using a weighted least-squares regression analysis, patients with the -308 TNFA AA plus AG genotypes (n ‫؍‬ 49) had significantly higher rates of progression in erosion scores (median 0.84 versus 0.48 units/year), joint space narrowing (JSN) scores (0.42 versus 0.04), and total Sharp scores (1.70 versus 0.61) compared with patients with the TNFA GG genotype (n ‫؍‬ 140). Presence of the SE (n ‫؍‬ 137) was associated with significantly lower progression rates (per year) for total Sharp scores (median 0.9 versus 1.25 units/year) and JSN scores (0.04 versus 0.41), but not for erosion scores (0.50 versus 0.61) compared with patients without the SE (n ‫؍‬ 52). In a least-squares multiple linear regression model, the presence of the AA plus AG genotypes was associated with a significantly higher progression rate after adjusting for the presence of the SE, interaction between the SE and the AA plus AG genotypes, baseline log C-reactive protein level, Health Assessment Questionnaire Disability Index, total Sharp score, swollen joint count, and presence of osteophytes (osteoarthritis). There was a strong linkage disequili-

“…Therapeutic strategies that have targeted individual pathophysiologic mediators, such as TNF␣ and IL-1, have produced significant clinical benefits for many, but not all, patients with RA (28)(29)(30)(31). Improved strategies may evolve from the combined targeting of more than one critical mediator of inflammation and destruction, or from upstream targeting at pivotal transcriptional levels.…”

Section: Discussionmentioning

confidence: 99%

Increased synovial tissue NF‐κB1 expression at sites adjacent to the cartilage–pannus junction in rheumatoid arthritis

Benito

Murphy

et al. 2004

Objective. To compare the expression of the Rel/ NF-B subunits, NF-B1 (p50) and RelA (p65), in paired synovial tissue samples selected from sites adjacent to and remote from the cartilage-pannus junction (CPJ) in patients with inflammatory arthritis.Methods. Synovial tissue was selected at arthroscopy from sites adjacent to the CPJ and from the suprapatellar pouch of patients who were referred to an early arthritis clinic. Tissue samples from patients with osteoarthritis (OA) undergoing knee arthroplasty were also studied. Rel/NF-B subunit activation and expression were measured by electrophoretic mobility shift assay and supershift analyses and by immunohistochemistry.Results. Tissue samples were obtained from 10 patients with rheumatoid arthritis (RA), 7 with a seronegative arthropathy (SnA), and 6 with OA. Rel/NF-B was abundantly expressed in all samples. In both RA and SnA synovial tissue, the absolute number of NF-B1؉ cells at the CPJ was significantly higher than at non-CPJ sites (P ‫؍‬ 0.006 and P ‫؍‬ 0.02, respectively). The proportion of cells expressing NF-B1 was also significantly higher at the CPJ compared with non-CPJ sites (P ‫؍‬ 0.003 in RA, P ‫؍‬ 0.009 in SnA). The numbers of RelA؉ cells were consistently lower throughout. In RA synovial tissue, but not in SnA synovial tissue, both the absolute number and the proportion of RelA؉ cells were significantly higher at the CPJ than at non-CPJ sites (P ‫؍‬ 0.003 and P ‫؍‬ 0.01, respectively). In OA synovial tissue, the numbers of cells expressing NF-B1 and RelA were similar to those observed at the non-CPJ sites in all inflammatory tissues studied.Conclusion. In this study of early inflammatory arthritis, expression of NF-B1 in synovial tissue was highest at sites most likely to be associated with joint erosion. These observations are consistent with a critical role of NF-B1 in joint destruction, and support the rationale for specific therapeutic inhibition of NF-B in RA.