Methotrexate achieves major cDAPSA response, and improvement in dactylitis and functional status in psoriatic arthritis

Abstract

Objective Despite the widespread clinical use of MTX in PsA, data from published randomized controlled studies suggest limited efficacy. The objective of the present study was to document the efficacy of MTX. Methods This was an open-label, prospective study of patients satisfying the ClASsification criteria for Psoriatic ARthritis study (CASPAR) criteria for PsA who received MTX in doses of ⩾15 mg/week throughout the follow-up period of 9 months. Disease activity was assessed across various domains by tender and swollen joint count, physician and patient global assessment, DAS-28 ESR, Clinical Disease Activity Index for PsA (cDAPSA), Leeds Dactylitis Instrument basic, Leeds Enthesitis Index (LEI), Psoriasis Area and Severity Index (PASI), Minimal Disease Activity and HAQ (CRD Pune version) at baseline and at 3, 6 and 9 months of follow-up. Response to therapy was assessed by EULAR DAS28 ESR, Disease Activity Index for PsA (cDAPSA) response, HAQ response and PASI75. MTX dose escalation and the use of combination DMARDS were dictated by disease activity. Results A total of 73 patients were included, with mean (s.d.) age 44 (9.7) years. The mean (s.d.) dose of MTX used was 17.5 (3.8) mg/week. Seven patients received additional DMARDS (LEF/SSZ). At the end of 9 months, significant improvement (P < 0.05) was noted in the tender joint count, swollen joint count, global activity, DAS-28ESR, cDAPSA, Leeds Dactylitis Index basic, LEI, PASI and HAQ. Major cDAPSA response was achieved in 58.9% of patients. EULAR DAS28 moderate and good response was achieved in 74% and 6.8% of patients, respectively. Minimal Disease Activity was achieved in 63% of patients. A PASI75 response and HAQ response was achieved in 67.9% and 65.8% of patients, respectively. Conclusion MTX initiated at ⩾15 mg/week with targeted escalation resulted in significant improvement in the skin, joint, dactylitis, enthesitis and functional domains of PsA.

Comparison between methotrexate and apremilast in Psoriatic Arthritis-a single blind randomized controlled trial (APREMEPsA study)

“…Both methotrexate and apremilast resulted in significant improvement in skin involvement in our study and there was no difference in change in PASI score between the two groups at 24 weeks. Similar results were noted in previous studies on the use of methotrexate and apremilast in patients with PsA [7,10,11,[13][14][15][16]18].…”

“…Major cDAPSA response at 24 weeks was noted in 20% patients in the apremilast group and 37.5% in the methotrexate group in our study. Previously, Appani et al reported major cDAPSA response in 43.8% of patients receiving methotrexate for 24 weeks, which is similar to that noted in our study [7]. Although there is no data about the major cDAPSA response with apremilast, recently Mease et al in their post-hoc analysis showed that around 25-47% patients achieved cDAPSA remission/low disease activity with apremilast depending on baseline disease activity [8].…”

“…In our study, methotrexate resulted in an improvement in dactylitis similar to that noted in the TICOPA trial and the study by Appani et al [7,10]. However, other studies failed to demonstrate a similar efficacy of methotrexate on dactylitis [11,12].…”

Effectiveness of Disease-Modifying Antirheumatic Drugs for Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort

“…[28] In yet another open label trial assessing the efficacy of methotrexate in various domains of PsA, a significant drop in mean LEI scores from 1.6 to 0.1 were noted in 6 months. [29] Assessment of efficacy of methotrexate in the TICOPA trial demonstrated a significant change in the proportion of patients with enthesitis from baseline to 12 weeks. [30] In this context, findings of the current study will have important implications for clinical practice in resource constrained settings that are heavily dependent on cDMARDs.…”

Tratamento das entesopatias. Parte 2 – Tratamento medicamentoso

“…O papel benéfico do metotrexato (MTX) sobre o domínio cutâneo, artrite periférica, dactilite e a maior probabilidade de alcançar a mínima atividade de doença tem sido demonstrado desde os primeiros dados dos estudos TICOPA (Tight Control of PsA) e MIPA (Methotrexate in Psoriatic Arthritis study). Por outro lado, os resultados sobre a entesite propriamente dita não são robustos [16][17][18][19] e, provavelmente, não demonstraram eficácia com relação a esse domínio até o momento. Além disso, não tem sido demonstrado qualquer efeito adicional na combinação com os inibidores do TNF-α 20 .…”