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THU0173 Achievement and Maintenance of Remission/Low Disease Activity over 24 Months in Patients with Rheumatoid Arthritis Treated with Etanercept or Etanercept + Methotrexate in the Canadian Methotrexate and Etanercept Outcome (CAMEO) Study
  1. J.E. Pope1,
  2. B. Haraoui2,
  3. J.C. Thorne3,
  4. K. Phan-Chronis4,
  5. M. Poulin-Costello5,
  6. A. Vieira6,
  7. E. Keystone7
  8. on behalf of the CAMEO Investigators
  1. 1University of Western Ontario, London
  2. 2University of Montreal Hospital Centre, Montreal
  3. 3Southlake Regional Health Centre, Newmarket
  4. 4Amgen Canada Inc
  5. 5Amgen Canada Inc
  6. 6Formerly Amgen Canada Inc., Mississauga
  7. 7Mount Sinai Hospital, University of Toronto, Toronto, Canada

Abstract

Background Remission (REM) or low disease activity (LDA) are key clinical targets in patients with rheumatoid arthritis (RA).1 The CAMEO study, an open-label trial in RA patients, demonstrated that those with LDA after 6 months of etanercept (ETN) and methotrexate (MTX) therapy had similar clinical outcomes at 12 months whether they continued ETN+MTX or switched to ETN monotherapy at month 6 (M6).2 Conversely, patients who had not achieved LDA at M6 showed reduced response when treated with ETN alone after withdrawing MTX.2

Objectives This post-hoc analysis of the CAMEO study examined the achievement and sustainability of REM or LDA for up to 24 months in patients who continued ETN+MTX or switched to ETN monotherapy following 6 months of combination therapy.

Methods TNF inhibitor naïve patients with active RA (≥3 swollen joints, Disease Activity Score [DAS28] ≥3.2), despite MTX therapy (≥15 mg/week or 10 mg/week if intolerant) for >12 weeks, were enrolled. Following 6 months of ETN (50 mg/week SC) + MTX treatment, patients were randomized (1:1) to continue ETN+MTX or to switch to ETN monotherapy for an additional 18 months. DAS28 was assessed at baseline through month 24 (M24).

Results A total of 258 patients enrolled (76% female, mean age 54.7±12.5 yrs, disease duration 8.9±8.4 yrs, baseline DAS28 5.4±1.1) and 205 (79%) were randomized at M6 to maintain ETN+MTX (n=107) or to begin ETN alone (n=98). Among patients who achieved REM (DAS28 <2.6) at M6, REM rates were similar at M24 whether on combination or monotherapy (Table 1). Similarly, in patients who achieved M6 LDA (DAS28 <3.2), the proportion of individuals maintaining LDA at M24 was comparable between treatment arms (ETN: 36% vs. ETN+MTX: 40%). In contrast, in subgroups without M6 REM or LDA but who achieved M12 REM or LDA, fewer patients in the ETN arm maintained REM (ETN: 2% vs. ETN+MTX: 6%; Table 1) or LDA (ETN: 0% vs. ETN+MTX: 10%) to M24. For patients without M6 REM, completion rates at M24 were 45% and 70% in the ETN and ETN+MTX arms, respectively; in patients achieving M6 REM, completion rates were 65% in the ETN arm and 70% in the ETN+MTX arm.

Table 1.

Sustained DAS28 REM (DAS28 <2.6) through month 24 in patients who achieved or did not achieve REM at M6*

Conclusions This analysis demonstrates that a substantial proportion of patients who achieve LDA/REM at M6 sustain LDA/REM through M24 whether on combination or monotherapy. These results suggest that ETN monotherapy may be considered in those patients who achieve LDA/REM after 6 months of combination therapy.

References

  1. Smolen JS, et al. Ann Rheum Dis. 2010;69:631-637.

  2. Pope JE, et al. Ann Rheum Dis. 2013 August [Epub ahead of print].

Acknowledgements Amgen Canada Inc. oversaw the design, conduct, and data collection and assisted in the analysis and interpretation of data.

Disclosure of Interest : J. Pope Grant/research support: Abbott/AbbVie, Amgen, Actelion, AstraZeneca Pharmaceuticals, Bristol-Meyers Squibb, Glaxo-Smith Kline, Hoffmann-LaRoche, Janssen, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, UCB, Consultant for: Abbott/AbbVie, Amgen, Actelion, AstraZeneca Pharmaceuticals, Bristol-Meyers Squibb, Glaxo-Smith Kline, Hoffmann-LaRoche, Janssen, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, UCB, B. Haraoui Grant/research support: Abbott/AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Pfizer, Roche, UCB, Consultant for: Abbott/AbbVie, Amgen, Bristol-Meyers Squibb, Merck, Pfizer, Roche, UCB, J. C. Thorne Grant/research support: Amgen, Pfizer, Abbott/AbbVie, Bristol-Myers Squibb, Centocor, Merck, Roche, UCB, Consultant for: Amgen, Pfizer, Abbott/AbbVie, Bristol-Myers Squibb, Centocor, Merck, Roche, UCB, K. Phan-Chronis Employee of: Amgen Canada, M. Poulin-Costello Employee of: Amgen Canada, A. Vieira Employee of: Amgen Canada (Former employee), E. Keystone Grant/research support: Abbott/AbbVie, Amgen, AstraZeneca Pharmaceuticals, Bristol-Meyers Squibb, Centocor, F. Hoffmann-LaRoche, Genzyme, Merck, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, UCB, Genentech, Janssen, Consultant for: Abbott/AbbVie, Bristol-Meyers Squibb, F. Hoffmann-LaRoche, Merck, Pfizer Pharmaceuticals, UCB, Janssen

DOI 10.1136/annrheumdis-2014-eular.1054

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