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SAT0131 Continuation/discontinuation of methotrexate and clinical response to etanercept determine the radiographic progression/repair in patients with rheumatoid arthritis: A subanalysis of 52-week results from the JESMR study
  1. H. Kameda1,
  2. K. Kanbe2,
  3. E. Sato2,
  4. Y. Ueki3,
  5. K. Saito4,
  6. S. Nagaoka5,
  7. T. Hidaka6,
  8. T. Atsumi7,
  9. M. Tsukano8,
  10. T. Kasama9,
  11. S. Shiozawa10,
  12. Y. Tanaka4,
  13. H. Yamanaka2,
  14. T. Takeuchi1
  1. 1Keio University
  2. 2Tokyo Women’s Medical University, Tokyo
  3. 3Sasebo Chuo Hospital, Sasebo
  4. 4University of Occupational and Environmental Health, Kitakyushu
  5. 5Yokohama Minami Kyosai Hospital, Yokohama
  6. 6Zenjinkai Shimin-No-Mori Hospital, Miyazaki
  7. 7Hokkaido University Graduate School of Medicine, Sapporo
  8. 8Kumamoto Orthopaedic Hospital, Kumamoto
  9. 9Showa University School of Medicine, Tokyo
  10. 10Kobe University, Kobe, Japan

Abstract

Background Recent aggressive treatments can halt the radiographic progression and even introduce the repair of damaged joints in a portion of patients with rheumatoid arthritis (RA).

Objectives The aim of this study is to elucidate how treatment strategies and clinical response to them determine the radiographic progression and repair in RA patients.

Methods In the JESMR study, 151 Japanese patients with active RA despite treatment with methotrexate (MTX) were randomized to either etanercept (ETN) 50 mg/week with 6-8 mg/week of MTX (the E+M group), or ETN alone (the E group) [ref.1]. Radiographs of the hands and feet were taken at baseline, week 24, and week 52 for the first year. Radiographs from 53 (72%) and 68 (88%) patients in the E group and the E+M group, respectively, were scored by two independent readers using the van der Heijde-modified Sharp score.

Results The cumulative probability plot of the American College of Rheumatology (ACR)-N at week 52 in 121 patients clearly demonstrated a superior response in the E+M group to that in the E group, and the ACR 50 response rate at week 52 in the E+M group were significantly greater than that in the E group (76.5% versus 50.9%, respectively; p=0.0041 by Fisher’s exact test). The mean progression in total score at week 52 was 5.9 in the ACR50 non-responders of the E group, whereas it was 0.8-1.3 in other populations (Table). Moreover, the rate of radiographic progressors defined by more than the smallest detectable change of 1.9 outweighed that of radiographic regressors, similarly defined, by around 30% in the E group, irrespective of the ACR50 response status. On the contrary, the rates of radiographic progressors balanced those of regressors in the E+M group. Finally, a multivariate logistic regression analysis identified the ACR50 response and MTX, as well as the baseline radiographic score, as independent predictive variables for radiographic outcome at week 52.

Conclusions Discontinuation of MTX and poor clinical response promoted radiographic progression than repair during ETN treatment in RA patients.

  1. Kameda H, et al. J Rheumatol 2011;38:1585-92.

Disclosure of Interest H. Kameda Speakers Bureau: Mitsubishi-Tanabe Pharma, Pfizer, Takeda Pharmaceutical Co Ltd, Abbott, Eisai Pharma, Bristol-Myers, K. Kanbe: None Declared, E. Sato: None Declared, Y. Ueki: None Declared, K. Saito: None Declared, S. Nagaoka Grant/Research support from: Pfizer, Speakers Bureau: Mitsubishi-Tanabe Pharma, Pfeizer, Abbott, Eisai, Chugai Pharma, and Bristol-Myers, T. Hidaka Speakers Bureau: Mitsubishi-Tanabe Pharma, Pfizer, Takeda Pharmaceutical Co Ltd, Abbott, Eisai Pharma, Janssen Pharma, Chugai Pharma, Bristol-Myers, Astellas Pharma, astrazeneca and Novartis, T. Atsumi Speakers Bureau: Mitsubishi-Tanabe Pharma, Pfizer, Takeda Pharmaceutical Co Ltd, Eisai Pharma, Chugai Pharma, Otsuka Pharma and Bristol-Myers, M. Tsukano: None Declared, T. Kasama Grant/Research support from: Mitsubishi-Tanabe Pharma, Pfizer, Eisai Pharma, and Chugai Pharma, Speakers Bureau: Mitsubishi-Tanabe Pharma, Pfizer, Abbott, Eisai Pharma, Janssen Pharma, Chugai Pharma, and Bristol-Myers, S. Shiozawa: None Declared, Y. Tanaka Grant/Research support from: Mitsubishi-Tanabe Pharma, Takeda Industrial Pharma, Banyu Pharma, Chugai Pharma, Eisai Pharma, Astellas Pharma, and Abbott Immunology Pharma, Speakers Bureau: Mitsubishi-Tanabe Pharma, Chugai Pharma, Eisai Pharma, Takeda Industrial Pharma, Astellas Pharma, Abbott Immunology Pharma, H. Yamanaka Grant/Research support from: Chugai Pharmaceutical Co.,Ltd., Astellas Pharma Inc., Pfeizer, Daiichi Sankyo Co.,Ltd., Banyu Pharmaceutical Co.,Ltd., Mitsubishi Tanabe Pharma Corporation, Abbott Japan Co.,Ltd., Eisai Co.,Ltd., Santen Pharmaceutical Co.,Ltd., Taishotoyama Pharmaceutical Co.,Ltd., Takeda Pharmaceutical Company Limited, Kissei Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Speakers Bureau: Abbott, Eisai Co.,Ltd., Takeda Pharmaceutical Company Limited, Mitsubishi Tanabe Pharma Corporation, Janssen Pharmaceutical K.K., Hoffmann-La Roche, Chugai Pharmaceutical Co.,Ltd, T. Takeuchi Grant/Research support from: Mitsubishi-Tanabe Pharma, Pfizer, Takeda Pharmaceutical Co Ltd, Eisai Pharma, and Chugai Pharma, Speakers Bureau: Mitsubishi-Tanabe Pharma, Pfizer, Takeda Pharmaceutical Co Ltd, Abbott, Eisai Pharma, Janssen Pharma, Chugai Pharma, Bristol-Myers, and Novartis

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