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Extended report
Application of composite disease activity scores in psoriatic arthritis to the PRESTA data set
  1. Oliver FitzGerald1,
  2. Philip Helliwell2,
  3. Philip Mease3,
  4. Aizad Mumtaz1,
  5. Laura Coates2,
  6. Ronald Pedersen4,
  7. Henk Nab5,
  8. Charles Molta4
  1. 1Department of Rheumatology, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
  2. 2Leeds Institute of Molecular Medicine, Section of Musculoskeletal Disease, University of Leeds, Leeds, UK
  3. 3Swedish Medical Center and University of Washington School of Medicine, Seattle, Washington, USA
  4. 4Department of Statistics, Pfizer Inc., Collegeville, Pennsylvania, USA
  5. 5Department of Rheumatology, Pfizer Europe, Rome, Italy
  1. Correspondence to Professor Oliver FitzGerald, Bone and Joint Unit, St Vincent's University Hospital, Elm Park, Dublin, Ireland; oliver.fitzgerald{at}


Objective This study aimed to compare the performances of the Modified Composite Psoriatic Disease Activity Index (mCPDAI) and the Disease Activity index for PSoriatic Arthritis (DAPSA) in an interventional study of etanercept in psoriatic arthritis.

Methods The components of the CPDAI and DAPSA were extracted using PRESTA (Psoriasis Randomized Etanercept STudy in subjects with psoriatic Arthritis) study data. Data for four of the five domains of the CPDAI—thus an mCPDAI—were available: joints, skin, dactylitis and enthesitis (spinal involvement was not assessed). Domains in the calculation of DAPSA were subjected to global assessment of pain, swollen and tender joint counts, and C reactive protein. Subjects were randomised to etanercept 50 mg weekly (n=373) or 50 mg twice weekly (n=379) for 12 weeks; all subjects then received etanercept 50 mg weekly for 12 weeks. The performance of the scores at baseline and on weeks 12 and 24 was compared between the two treatment regimens.

Results The mCPDAI and DAPSA could distinguish response to treatment comparing baseline and 12-week or 24-week values (p<0.0001). The mCPDAI, not DAPSA, could distinguish response between the two treatment groups at 12 weeks (p=0.0492), but not at 24 weeks. All domains evaluated contributed to the data variability of the mCPDAI; the most significant were dactylitis (r=0.64) and enthesitis (r=0.60).

Conclusion In psoriatic arthritis with severe skin involvement, the mCPDAI was able to distinguish treatment response between the two etanercept doses. DAPSA, while demonstrating improvement in both groups over time, was unable to distinguish response between the different doses of etanercept. Further studies are needed to confirm the sensitivity of both indexes.

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  • Funding Wyeth Research, acquired by Pfizer Inc.

  • Competing interests OFG, PH, PM and LC received money for consultancy and/or money for travel/accommodations/meeting expenses from Abbott, Centocor, Janssen Cileg and Pfizer. AM received money for Abbott Newman clinical research fellowship. RP, HN and CM are employees or former employees of Wyeth Research and Pfizer Inc.

  • Ethics approval Ethics approval was obtained from an independent ethics committee or from the institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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