Less Radiographic Progression with Adalimumab Plus Methotrexate Versus Methotrexate Monotherapy Across the Spectrum of Clinical Response in Early Rheumatoid Arthritis
Less Radiographic Progression with Adalimumab Plus Methotrexate Versus Methotrexate Monotherapy Across the Spectrum of Clinical Response in Early Rheumatoid Arthritis
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DOI：
10.3899/jrheum.081018
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发表时间：
2009-07-01
影响因子：
3.9
通讯作者：
Sasso, Eric H.
中科院分区：
文献类型：
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作者：
Emery, Paul;Genovese, Mark C.;Sasso, Eric H.
目标。在PREMIER研究中，确定阿达木单抗加甲氨蝶呤（MTX）与单药治疗早期类风湿关节炎（RA）患者的影像学进展与临床反应之间的关系。接受阿达木单抗加MTX （n = 240）、阿达木单抗（n = 222）或MTX （n = 216）治疗的早期RA患者按美国风湿病学会（ACR）反应、29-关节疾病活动评分（DAS28）或缓解样状态(压痛关节计数(TJC) = 0；Das28 < 2.6；肿胀关节计数= 0:26周和104周时acr1001。通过累积概率图评估放射学进展。总夏普评分（Delta TSS）的平均变化。进展者百分比（TSS δ > 0.5）。临床结果包括ACR20无反应和缓解样反应。阿达木单抗加MTX治疗在26周和104周时的放射学进展比MTX单药治疗少。阿达木单抗单药治疗通常是中间的。一个强大的。仅甲氨蝶呤单药治疗的临床反应与影像学疗效呈正比关系。单药治疗仅在缓解样应答者中接近阿达木单抗加MTX的放射学疗效，尽管对于TJC = 0的患者，与阿达木单抗加MTX相比，MTX单药治疗的进展明显更大。在第104周，阿达木单抗联合MTX治疗的同时临床（DAS28 < 2.6）和放射学（Delta TSS: 50.5）缓解（45%）明显高于阿达木单抗（25%）或MTX单药（18%）治疗。在早期RA患者中，阿达木单抗加MTX在临床反应谱上的放射学进展小于MTX单药治疗，包括ACR20无反应和缓解样反应。（首次发布2009年4月15日J Rheumatol 2009:36: 1429-41； doi: 10.3899/ jrheumat.081018）
Objective. To determine the relationship between radiographic progression and clinical response for adalimumab plus methotrexate (MTX) versus either monotherapy in patients with early rheumatoid arthritis (RA) in the PREMIER study.Methods. Patients with early RA who received adalimumab Plus MTX (n = 240), adalimumab (n 222), or MTX (n = 216) were grouped by American College of Rheumatology (ACR) response, 29-joint Disease Activity Score (DAS28), or remission-like state [tender joint count (TJC) = 0; DAS28 < 2.6; swollen joint Count = 0: ACR 1001 at 26 and 104 weeks. Radiographic progression was assessed by cumulative probability plots. mean changes in total Sharp score (Delta TSS). and percentages of progressors (Delta TSS > 0.5).Results. Across the spectrum of clinical Outcomes, including ACR20 nonresponses and remission-like responses. therapy with adalimumab plus MTX permitted less radiographic progression at Weeks 26 and 104 than MTX monotherapy. Adalimumab monotherapy was generally intermediate. A strong. proportional relationship was observed between clinical response and radiographic efficacy only for MTX monotherapy. The monotherapies approximated the radiographic efficacy of adalimumab Plus MTX only among remission-like responders, although progression was significantly greater with MTX monotherapy versus adalimumab plus MTX for patients with TJC = 0. Concurrent clinical (DAS28 < 2.6) and radiographic (Delta TSS :5 0.5) remission was significantly more frequent at Week 104 with adalimurnab Plus MTX (45%) than with adalimumab (25%) or MTX (18%) monotherapy.Conclusion. In patients with early RA, adalimumab plus MTX resulted in less radiographic progression than MTX monotherapy across the Spectrum of clinical response, including ACR20 non-responses and remission-like responses. (First Release April 15 2009 J Rheumatol 2009:36: 1429-41; doi: 10.3899/jrheum.081018)