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Combination etanercept and methotrexate provides better disease control in very early (≤4 months) versus early rheumatoid arthritis (>4 months and <2 years): post hoc analyses from the COMET study
  1. Paul Emery1,2,
  2. Tore K Kvien3,
  3. Bernard Combe4,
  4. Bruce Freundlich5,
  5. Deborah Robertson6,
  6. Tahmina Ferdousi6,
  7. Eustratios Bananis6,
  8. Ronald Pedersen6,
  9. Andrew S Koenig6
  1. 1Division of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  2. 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
  3. 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Department of Rheumatology, Hospital Lapeyronie, Montpellier I University, Montpellier, France
  5. 5Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  6. 6Inflammation and Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
  1. Correspondence to Paul Emery, Arthritis Research UK Professor of Rheumatology, Director of Musculoskeletal Division. Division of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Chapeltown Road, Leeds LS7 4SA, UK; p.emery{at}


Objective The objective of this post hoc analysis was to test the benefits of treating very early rheumatoid arthritis (VERA; ≤4 months) using COMET trial data. Treatment response in VERA and early rheumatoid arthritis (ERA; >4 months to 2 years) with combination etanercept+methotrexate (ETN+MTX) or MTX monotherapy was compared.

Methods Data assessed at week 52 for baseline disease duration effect included remission (disease activity score (DAS)28 <2.6, SDAI ≤3.3, Boolean), low disease activity (LDA; DAS28 <3.2), Boolean components of remission and radiographic non-progression. Subjects who discontinued because of lack of efficacy were included as non-responders.

Results Higher proportions of VERA subjects achieved LDA (79%) and DAS28 remission (70%) than ERA (62%, 48%, respectively, p<0.05) with ETN+MTX. Such high responses with MTX monotherapy were not observed (VERA, LDA=47%, DAS28 remission=35%; ERA, 47% and 32% respectively, p>0.70 for each). Regardless of disease duration, no radiographic progression was seen in 80% of subjects with ETN+MTX. In contrast, a higher proportion of VERA subjects showed no radiographic progression compared with ERA subjects treated with MTX (73.9% vs 50%, p=0.01).

Conclusions Treatment of VERA with ETN+MTX provides qualitatively improved clinical outcomes not seen with MTX monotherapy, supporting the pivotal role of TNF inhibition in early disease.

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  • Handling editor Johannes WJ Bijlsma

  • Competing interests The sponsor designed the study and provided assistance in manuscript preparation; data were held and analysed by the sponsor. All authors contributed to data interpretation and prepared, reviewed and approved the manuscript for submission. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication.

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

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