Background Influence of the different types of treatment on treatment-to-target (T2T) strategy results for early psoriatic arthritis (EPsA) has not been studied yet.
Objectives To compare attainment of remission and minimal disease activity (MDA) using Methotrexate (MTX) subcutaneous (s/c) monotherapy or also in combination with Adalimumab (ADA) after one year of T2T strategy.
Methods 25 (M/F – 9/16) DMARD-naïve patients (pts) with active EPsA, according to the CASPAR criteria, mean age 38.6±10.3 years, PsA duration 12 [5; 24] months, psoriasis (PsO) duration 36 [12; 84] months, disease activity index (DAS) 3.9 [3.1; 4.7], modified composite psoriatic disease index (joint-enthesis-dactylitis-skin domains) (mCPDAI) 8 [7; 8] after signing a consent form for the participant in the REMARCA [Russian invEstigation of MethotrexAte and biologics in eaRly aCtive inflammatory Arthritis] study were included. At baseline and every other 3 months for total 12 months of therapy all pts underwent standard clinical examination, including Tender Joint count (TJC78), Swollen Joint Count (SJC76), dactylitis, enthesitis, patient pain VAS, patient global disease activity VAS, physician's global disease activity VAS, DAS, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire (HAQ), Dermatology Quality Life Index (DQLI). The dose of MTX s/c was escalated by 5 mg every 2 weeks from 10 mg/wk to appropriate dose 20-25 mg/wk according to the drug intolerance. If pts did not achieve the MDA or remission after 3 months of MTX mono-therapy, then combination therapy of MTX+ADA 40 mg every two weeks was continued up to one year. At 12 months of therapy the proportion of pts who attained DAS<1.6/mCPDAI=0 remission or MDA, ACR20/50/70 were calculated. Mean ± SD, Me [Q25; Q75], %, Fisher's exact test, Friedman (Fr.) ANOVA, U-test were performed. All p<0.05 were considered to indicate statistical significance.2
Results By 12 months of therapy 12 out of 25 and 13 out of 25 pts were treated by MTX-mono therapy and combination therapy with MTX+ADA accordingly. At baseline pts following to MTX-mono therapy had significantly lower PsA activity by DAS/mCPDAI compare to these following to combination therapy MTX+ADA: 3.3 [2.6; 3.9]/7.5 [6; 8] and 4.7 [3.7; 5.0]/8 [8; 9] respectively (U-test, p<0.03 for all). At 12 months of therapy DAS remission achieved 7 (58.3%)/7 (53.8%) of pts, mCPDAI remission achieved 9 (75%)/16 (46.2%) of pts, MDA was seen in 9 (75%)/8 (61.5%) of pts with MTX-mono/MTX+ADA combination therapy accordingly (Fisher's exact test p=0.25-0.52-0.67 respectively). ACR 20/50/70 were observed in 12 (100%)/11 (84.6%) of pts and in 10 (83.3%)/10 (76.9%) of pts and in 7 (58.3%)/8 (61.5%) of pts with MT-mono/MTX+ADA combination therapy accordingly (Fr. ANOVA, p=0.48 for all). By 12 months of therapy no significant differences were found in PsA activity by DAS/mCPDAI between pts with MTX-mono and MTX+ADA combination therapy: 1.3 [0.9; 2.1]/2.5 [1.5; 3.5] and 1.6 [1.3; 2.2]/4 [2; 7], U-test, p=0.568 and p=0.174, accordingly.
Conclusions One year of T2T strategy with tight control over reached remission and MDA provides similar response rates regardless of the type of therapy in active EPsA.
Disclosure of Interest None declared