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42. Kongress der Deutschen Gesellschaft für Rheumatologie, 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 24. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

17.-20. September 2014, Düsseldorf

Is anti-TNF Treatment response in peripheral Psoriatic Arthritis influenced by concomitant use of Methotrexate?

Meeting Abstract

  • Frank Behrens - CIRI am Klinikum der Johann Wolfgang Goethe-Universität, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
  • Michaela Köhm - CIRI am Klinikum der Johann Wolfgang Goethe-Universität, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
  • Uta Arndt - Rheumapraxis Hofheim, Hofheim
  • Diamant Thaci - Exzellenzzentrum Entzündungsmedizin der Universität zu Lübeck, Dermatologie, Lübeck
  • Eva Christina Scharbatke - Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Schwerpunkt Rheumatologie und klinische Immunologie, Würzburg
  • Hans-Peter Tony - Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Schwerpunkt Rheumatologie und klinische Immunologie, Würzburg
  • Harald Louis Burkhardt - Klinikum der Johann Wolfgang Goethe-Universität, Medizinische Klinik II, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 42. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 24. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Düsseldorf, 17.-20.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocSP.04

doi: 10.3205/14dgrh237, urn:nbn:de:0183-14dgrh2370

Published: September 12, 2014

© 2014 Behrens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Background: In active psoriatic arthritis (PsA) the efficacy of TNF-inhibitors (TNFi) has been proven in randomized clinical trials (RCT). Methotrexate (MTX) co-medication can improve the therapeutic benefit of TNFi in rheumatoid arthritis (RA), but its role in PsA remains unclear. Thus, distinct patterns of disease manifestations such as peripheral joint and axial involvement might influence the choice of co-medication, treatment response and drug adherence differently in PsA. Accordingly, an appropriate study on the impact of MTX on TNFi treatment in PsA has to consider the confounding effects of the distinct disease manifestations on outcome measures.

Methods: Data of a large (n=1455) German multicentre, non-interventional study (NIS) with active PsA patients treated with Adalimumab (ADA) in routine care was analysed. Patients with exclusive peripheral arthritis (pPsA) i.e. no evidence for axial involvement, enthesitis and dactylitis were analysed and compared to those with additional musculoskeletal manifestations (aPsA). Safety and efficacy of ADA-monotherapy were analysed and compared to the results obtained by add-on treatment to MTX pre-medication. Besides documentation of demographic data, disease activity assessments (number of swollen (SJC), tender joints (TJC), disease activity score 28 (DAS28)) were calculated at baseline, month 3, 6, 12, 24. Step-wise regression analysis for influence of MTX on patient-outcome was calculated.

Results: Outcome in patients with peripheral PsA is independent from concomitant MTX use as indicated in DAS28 results (pPsA: ADA+MTX 2.58, ADA-Monotherapy 2.70; aPsA: ADA+MTX 2.82, ADA-Monotherapy 2.79 respectively). Moreover, treatment responses remained robust to changes of MTX co-medication either by discontinuation in combined TNFi therapy or by addition to TNFi-monotherapy. In step-wise regression analysis no parameters for MTX were found to influence patient-outcome.

Conclusion: In active peripheral PsA co-medication of MTX added to TNFi treatment with ADA has no relevant impact on efficacy and safety. Not even the addition of MTX to ongoing TNFi treatment or refusal of MTX in combinational therapy with TNFi exhibits any influence on outcome parameters. RCTs are needed to confirm the data.