The role of methotrexate co-medication in TNF-inhibitor treatment in patients with psoriatic arthritis: results from 440 patients included in the NOR-DMARD study
- 3 January 2013
- journal article
- research article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 73 (1), 132-137
- https://doi.org/10.1136/annrheumdis-2012-202347
Abstract
The role of co-medication with tumour necrosis factor inhibitors (TNFi) is well established in rheumatoid arthritis and ankylosing spondylitis. In psoriatic arthritis (PsA) there is little evidence available on this issue. The analyses were based on data from the Norwegian longitudinal observational study on disease-modifying antirheumatic drugs (NOR-DMARD). Patients with PsA starting their first TNFi, either as monotherapy or with concomitant methotrexate (MTX), were selected. Baseline characteristics, responses after 3, 6 and 12 months, and drug survival were compared between those with and without MTX co-medication. A secondary analysis was performed on patients who had confirmed swollen joints at baseline. Cox regression was used to identify predictors of discontinuation. We included 440 patients, 170 receiving TNFi as monotherapy and 270 receiving concomitant MTX. The groups had similar baseline characteristics, except for number of swollen joints, which was higher in the concomitant MTX group. Responses were similar in the two groups in both analyses. Drug survival analyses revealed a borderline significant difference in favour of patients receiving co-medication (p=0.07), and this was most prominent for patients receiving infliximab (IFX) (p=0.01). In the Cox regression analysis lack of concomitant MTX and current smoking were independent predictors of discontinuation of TNFi. We found similar responses to TNFi in patients with and without concomitant MTX, but drug survival was superior in patients receiving co-medication. The effect of MTX on drug survival was most prominent in patients receiving IFX. Smoking at baseline and use of TNFi as monotherapy were identified as independent predictors of drug discontinuation.This publication has 22 references indexed in Scilit:
- 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritisAnnals Of The Rheumatic Diseases, 2011
- The effect of immunomodulators on the immunogenicity of TNF-blocking therapeutic monoclonal antibodies: a reviewArthritis Research & Therapy, 2010
- Golimumab, a new human tumor necrosis factor α antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty‐four–week efficacy and safety results of a randomized, placebo‐controlled studyArthritis & Rheumatism, 2009
- Maintenance of infliximab treatment in ankylosing spondylitis: Results of a one‐year randomized controlled trial comparing systematic versus on‐demand treatmentArthritis & Rheumatism, 2007
- The PREMIER study: A multicenter, randomized, double‐blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatmentArthritis & Rheumatism, 2005
- Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: Results of a double‐blind, randomized, placebo‐controlled trialArthritis & Rheumatism, 2005
- Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trialAnnals Of The Rheumatic Diseases, 2005
- Etanercept treatment of psoriatic arthritis: Safety, efficacy, and effect on disease progressionArthritis & Rheumatism, 2004
- Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trialThe Lancet, 2004
- Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trialThe Lancet, 2000