Background In patients with rheumatoid arthritis (RA), current treatment strategies aim for clinical remission. Knowing which patients are likely to respond to biologic treatment is helpful when considering treatment options.
Objectives To evaluate baseline characteristics that predict remission after 6 months of add-on golimumab (GLM) treatment in patients with active RA despite disease-modifying antirheumatic drug (DMARD) therapy.
Methods GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients with active RA (28-joint disease activity score based on erythrocyte sedimentation rate [DAS28-ESR] ≥3.2) despite DMARD therapy.1 Patients received 50-mg subcutaneous GLM once monthly for 6 months. In post hoc analyses, univariate logistic regression models were used to examine relationships between month-6 remission (DAS28-ESR <2.6) and several baseline demographic and disease characteristics, including components of DAS28-ESR. Covariates were age, sex, smoking history, comorbidities, number of previously failed DMARDs, baseline methotrexate (MTX) dose, disease duration, tender joint count (TJC28), swollen joint count (SJC28), ESR (log), patient global assessment of disease activity (PGA), and health assessment questionnaire (HAQ) score category (0 to 1.125; >1.125 to <1.75; or ≥1.75). Factors were evaluated in a stepwise fashion; those with significant associations (P<.10) were included in a final multivariate model.
Results In 3280 efficacy-evaluable patients, mean disease duration was 7.6 years; mean DAS28–ESR was 5.97 (SD=1.095). Overall, 23.9% (784/3280) of patients attained remission after 6 months' GLM treatment.1 The final multivariate analyses of 6-month DAS28-ESR remission did not include baseline MTX dose, previously failed DMARDs, disease duration, PGA, and SJC28 because they were not significant in initial analyses. In the final model, lower likelihood of remission was associated with being female (vs male, odds ratio [OR]=.652, P<.0001), older age (continuous variable, OR=.984, P<.0001), and higher HAQ score category (OR=.622 for the highest vs lowest categories [P<.0001]; OR=.713 for the medium vs lowest categories [P=.002]). Greater likelihood of remission was associated with lower baseline ESR (OR=.565) and TJC28 (OR=.943), P<.0001, and absence of comorbidities (OR=1.393; P=.0017). Smoking status was not associated with remission.
Conclusions In this large, multinational, observational study of patients with RA treated with GLM, attainment of 6-month remission was associated with several baseline predictors, notably sex, ESR, TJC28, comorbidities, and HAQ. Factors not associated with remission included disease duration, SJC, number of failed DMARDs, and MTX dose.
Combe B et al. Ann Rheum Dis. doi:10.1136/annrheumdis-2013-203229. Accessed 16 Dec. 2013.
Disclosure of Interest P. Durez: None declared, K. Pavelka Consultant for: Amgen, Roche, BMS, MSD, and UCB, M. Lazaro Grant/research support: Bristol Myers Squibb Argentina, Consultant for: Abbott Laboratories and MSD, A. Garcia Kutzbach: None declared, R. Moots: None declared, H. Amital: None declared, R. Yao Employee of: Merck, S. Huyck Employee of: Merck, M. Govoni Employee of: Merck, H. Weng Employee of: Merck, N. Vastesaeger Employee of: Merck
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