Efficacy and tolerability of anti-tumour necrosis factor therapy in psoriatic arthritis patients: results from the South Swedish Arthritis Treatment Group register

Kristensen, Lars Erik; Gülfe, Anders; Saxne, Tore; Geborek, Pierre

doi:10.1136/ard.2007.073544

Cited by 156 publications

(159 citation statements)

References 26 publications

(30 reference statements)

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“…To further analyze drug tolerability, we examined withdrawal rates during the 24 months of therapy. Other studies in patients with PsA have found that MTX increases the rate of persistence with anti-TNF therapy 6,7,8 and that PsA patients treated with ADA plus MTX have higher serum concentrations of ADA than those treated with ADA alone 16,17 , possibly due to suppression of development of anti-ADA antibody. However, our findings do not support an increased rate of treatment persistence with ADA in patients receiving concomitant MTX.…”

Section: Rheumatologymentioning

confidence: 99%

“…There is some evidence that MTX may contribute to improved treatment persistence with anti-TNF therapy 6,7 , particularly when used in combination with infliximab, but there are few data to support a benefit in effectiveness outcomes in patients with PsA treated with concomitant MTX and TNF inhibitors, including adalimumab (ADA) 8,9 . Consequently, the latest European League Against Rheumatism guidelines for the pharmacologic management of PsA include studies of combination therapies with conventional disease-modifying antirheumatic drugs (DMARD) and biologic agents on the research agenda 10 .…”

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confidence: 99%

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Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study

Behrens

Koehm²,

Arndt³

et al. 2015

J Rheumatol

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Objective.To examine the influence of concomitant methotrexate (MTX) with adalimumab (ADA) on outcomes in patients with psoriatic arthritis (PsA) using data from an observational study of ADA.Methods.Data from a German noninterventional study of patients with PsA starting treatment with ADA were analyzed retrospectively for effects of concomitant MTX on key outcomes, including Disease Activity Score-28 joints, tender and swollen joint counts, skin assessments, and safety. Patients were categorized into those with symptoms of axial involvement and those with no symptoms of axial involvement as judged by the examining clinician.Results.A total of 1455 patients met the study criteria, 296 with axial involvement (ADA monotherapy = 165; plus MTX = 131) and 1159 with no axial involvement (ADA monotherapy = 658; plus MTX = 501). ADA, alone or combined with MTX, resulted in strong and comparable reductions in disease activity measures in patients with and those without axial disease over 24 months of therapy. In multiple regression analyses, concomitant MTX did not affect joint or skin outcomes in either the group with axial manifestations or the group without axial disease. Neither adverse event rates nor withdrawal rates were significantly influenced by concomitant MTX.Conclusion.ADA is an effective treatment option for patients with PsA with or without axial involvement. Compared with ADA monotherapy, the use of concomitant MTX with ADA does not improve articular or skin outcomes in patients with PsA regardless of axial symptoms. Trial registration: Clinicaltrials.govNCT01111240

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Section: Rheumatologymentioning

confidence: 99%

mentioning

confidence: 99%

Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study

Behrens

Koehm²,

Arndt³

et al. 2015

J Rheumatol

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“…In particular, hsCRP has been shown to be independently associated with PsA (8), and high CRP levels were shown to protect against treatment termination in both PsA (9) and rheumatoid arthritis trials (see references in [9]). These studies have shown that clinical response and continuation of patients with PsA to treatment are uniformly correlated to the baseline CRP level and that increased systemic inflammation indicates a greater potential for treatment response (9). While there is no clear evidence indicating that CRP level is directly correlated to PsO or PsA disease severity, some studies have suggested a possible relationship.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Trial Data for Infliximab and Golimumab: Baseline C‐Reactive Protein Level and Prediction of Therapeutic Response in Patients With Psoriatic Arthritis

Ramírez-Fort

Gottlieb

2014

Arthritis Care & Research

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Objective. Anti-tumor necrosis factor medications have demonstrated good efficacy in treating psoriatic arthritis (PsA).Clinical responses at the primary end point in recent clinical trials of golimumab in PsA subjects yielded lower American College of Rheumatology 20% criteria for improvement (ACR20) responses than those seen in the Infliximab Multinational Psoriatic Arthritis Controlled Trial 2 infliximab study. However, baseline C-reactive protein (CRP) levels of PsA subjects enrolled in these trials differed significantly. We hypothesized that baseline CRP levels predict the observed differing clinical response rates at the primary end point. Methods. Combining the data from the infliximab and golimumab trials, we stratified the data by baseline CRP levels and then correlated these cohorts with response to treatment, specifically the Psoriasis Area and Severity Index and the ACR20, ACR50, and ACR70 responses. Results. The mean baseline CRP level in the infliximab trial was 1.9 mg/dl versus 1.4 mg/dl in the golimumab trial. Only 23% of golimumab subjects had a CRP level >1.7 mg/dl versus 35% of infliximab subjects (P ‫؍‬ 0.0023). All subjects with a CRP level >1.7 mg/dl at baseline achieved higher ACR20, ACR50, ACR70 response rates (56%, 36%, and 18%, respectively) at the primary end point of 14 weeks in the infliximab and golimumab clinical trials than any subjects with a CRP level <1.7 mg/dl (48%, 28%, and 13%, respectively [P ‫؍‬ 0.045, P ‫؍‬ 0.027, and P ‫؍‬ 0.089, respectively]).Conclusion. These results demonstrate that an increased baseline CRP level predicted improved therapeutic response at the primary end point for subjects treated with both golimumab and infliximab. To allow for comparison between future drug development studies and meta-analyses, baseline CRP levels should be factored into the multivariate analysis.

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“…104 Of these patients, 119 were prescribed etanercept 25 mg twice weekly. In this treatment group, drug continuation was signifi cantly associated with a high CRP at baseline and simultaneous MTX use.…”

Section: Safety In Psoriatic Arthritis Patientsmentioning

confidence: 99%

The Treatment of Ankylosing Spondylitis and Psoriatic Arthritis with Etanercept: A Comprehensive Review

Collamer

Battafarano

2009

Clinical Medicine. Therapeutics

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Etanercept is a dimeric recombinant soluble tumor necrosis factor (TNF) receptor protein utilized in the treatment of various infl ammatory diseases, including ankylosing spondylitis and psoriatic arthritis. Etanercept binds the proinfl ammatory cytokine TNF and blocks its interaction with soluble TNF receptors, thus decreasing the infl ammatory response. Several randomized controlled clinical trials have demonstrated the effi cacy, safety and tolerability of etanercept in the treatment of both ankylosing spondylitis and psoriatic arthritis. These trials have also shown signifi cant reductions in markers of systemic infl ammation and improvements in patient-reported quality of life measures. Inhibition of radiographic progression has been established in etanercept-treated psoriatic arthritis patients, and ankylosing spondylitis patients have demonstrated decreases in bony infl ammation; however, current data does not support a reduction in bone proliferation in ankylosing spondylitis patients. Concerns regarding long-term toxicity, effi cacy, and cost-effectiveness considerations persist and guidelines have been published to assist the clinician with appropriate patient selection for this biologic therapy. Current data indicates etanercept therapy has been a very successful and well-tolerated therapy for numerous ankylosing spondylitis and psoriatic arthritis patients and will likely continue to be a cornerstone therapy for treatment of these challenging diseases in the foreseeable future.

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Efficacy and tolerability of anti-tumour necrosis factor therapy in psoriatic arthritis patients: results from the South Swedish Arthritis Treatment Group register

Abstract: Concomitant MTX and high CRP levels are associated with treatment continuation of anti-TNF therapy in patients with PsA regardless of joint distribution. The positive effect of MTX was primarily linked to fewer dropouts because of adverse events.

Cited by 156 publications

References 26 publications

Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study

Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study

Analysis of Trial Data for Infliximab and Golimumab: Baseline C‐Reactive Protein Level and Prediction of Therapeutic Response in Patients With Psoriatic Arthritis

The Treatment of Ankylosing Spondylitis and Psoriatic Arthritis with Etanercept: A Comprehensive Review

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