Background Treat to target (T2T) strategy for spondyloarthritis, including psoriatic arthritis (PsA) has been recently proposed. The main goal of this strategy is to reach remission or low/minimal disease activity (MDA).
Objectives to investigate T2T strategy with methotrexate (MTX) subcutaneous (s/c) and anti-TNF-therapy (adalimumab) in active early peripheral psoriatic arthritis (EPsA).
Methods 23 (M/F – 8/15) treatment-naïve patients (pts) with active peripheral EPsA, according to the CASPAR criteria, mean age 39.1±10.6 yrs., PsA duration 7 [4; 24] mo., disease activity index (DAS) 3.97 [3.07; 4.67], DAS28 4.33 [3.68; 4.73], Psoriasis duration 36 [12; 84] mo., PASI 6 [3.1;9.7], BSA (%) 1 [0.5; 3.65], HAQ 0.75 [0.63; 1.25], C-reactive protein (C-RP, mg/l) 15 [8.6;25.1], ESR (mm/h) 15 [8.6;25.1] were included. At the baseline and every other 3 mo. of therapy all pts underwent standard clinical examination: Tender Joint count (TJC78/28), Swollen Joint Count (SJC76/28), patient pain VAS, patient/physician's global disease activity VAS, PASI, BSA, HAQ, DAS, DAS28, C-RP (mg/l), ESR (mm/h). Response to the treatment was defined as percentage of pts who met remission (DAS<1.6 or DAS28<2.6), low disease activity (LDA) (1.6≤DAS<2.4 or 2.6≤DAS28<3.2), MDA, ACR20/50/70. The dose of MTX (s/c) was escalated by 5 mg eow from 10 mg/wk to 20 mg/wk. If pts do not achieve the MDA/LDA or remission after 3 mo. MTX mono-therapy (MoT) combination therapy (CoT) MT+Adalimumab (ADA) 40 mg s/c eow will start. Mean ± SD, Me [Q25; Q75], χ2-test, Friedman ANOVA were performed. All p<0.05 were considered to indicate statistical significance.
Results Significant changes in baseline data up to 6 mo. of therapy are now avalible.
After 3 mo. of therapy MoT MTX remission by DAS/DAS28 was seen in 13%/22.7%, LDA by DAS/DAS28 in 21.7%/27.3% and MDA in 26.1% of pts. ACR 20/50/70 was achieved 65.2%/26.15/8.7% of pts accordingly. After 3 mo. 4 pts had high disease activity and were treated by CoT MT+ADA 40 mg s/c eow, 19 pts were continued MTX MoT. After 6 mo. remission by DAS/DAS28 was seen in 34.8%/39.1%, LDA by DAS/DAS28 in 26.1%/39.1% and MDA in 47.8% of pts. ACR 20/50/70 was achieved 73.9%/60.9%/47.8% of pts accordingly. After 6 mo. of MTX MoT (n=19) remission by DAS/DAS28 was seen in 36.8%/36.8%, LDA in 15.8%/36.8%, MDA in 47.4% of pts. ACR 20/50/70 was achieved 68.4%/52.6/42.1% of pts. MTX+ADA CoT (n=4) ACR 20/50/70 and MDA was achieved 100%/100%/75% and 50% of pts accordingly.
Conclusions T2T strategy - active treatment of EpsA pts with predominantly MoT MTX s/c for 6 mo. show MDA in a half of pts (47.8%), remission by DAS in a third (34.8%) and ACR20/50/70 achieved 73.9%/60.9%/47.8% of pts accordingly.
Disclosure of Interest None declared
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