Objectives: To compare the response to treatment with tumour necrosis factor (TNF) inhibitors and methotrexate (MTX) monotherapy in patients with psoriatic arthritis (PsA) within a real-life clinical setting.
Methods: We analysed data from an ongoing longitudinal, observational multicentre study in Norway. Our data comprised 526 cases of patients with PsA who received either anti-TNF treatment (n = 146) or MTX monotherapy (n = 380) and were followed for at least 6 months with measures of disease activity, health status and utility scores. A propensity score was computed to adjust for channelling bias. The changes in measures of disease activity and health-related quality of life from baseline to 3- and 6-month follow-up were compared between the groups with adjustments for the baseline value of the dependent variable and the propensity score (analyses of covariance (ANCOVA)).
Results: The groups were significantly different at baseline with respect to demographic and disease activity measures. The variables included in the propensity score were age, sex, number of previous disease modifying anti-rheumatic drugs (DMARDs), presence of erosive disease, treatment centre and investigator’s global assessment. The adjusted changes at 6 months were significantly larger in the anti-TNF group for ESR, DAS-28, M-HAQ, patient’s assessments of pain, fatigue and global disease activity on a visual analogue scale (VAS) and 4 out of 8 SF-36 dimensions.
Conclusions: Clinical improvement was superior with TNF inhibitors compared to MTX monotherapy in patients with PsA, when assessed in this setting of daily clinical practice.
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Published Online First 9 January 2007
Research grants for the NOR-DMARD study have been received from Abbott, Amgen, Wyeth, Aventis, MSD, Schering-Plough/Centocor and the Norwegian Directorate for Health and Social affairs. This work was supported by The Norwegian Women’s Public Health Association.
Competing interests: MSH has received honoraria as a speaker and consultant from Abbott and Wyeth. CK reports no conflicts of interest. ER has received investigator honoraria from Abbott. KM has received speaker honoraria from Abbott. WK has received speaker honoraria from different pharmaceutical companies, including Wyeth and Schering-Plough. PM reports no conflicts of interest. TKK has received research grants and honoraria as a speaker and consultant from several pharmaceutical companies, including Abbott, Schering-Plough and Wyeth.