Tuesday, 21 May 2019

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Early TNF inhibition in Early Psoriatic Arthritis

Early and aggressive DMARD therapy is ideal for most patients with inflammatory disorders. A small, double-blind, randomised, placebo-controlled trial in early psoriatic arthritis (PsA) has shown that first-line use of golimumab and methotrexate (MTX) is superior to MTX alone in inducing remission in PsA.

They conducted an investigator-initiated, multicentre, double-blind, randomised, placebo-controlled trial, enrolling 51 PsA patients who were MTX and bDMARD-naive (fulfilling the CASPAR criteria) and had active disease at baseline (≥3 swollen joint count/tender joint count). The primary endpoint was the number achieving Disease Activity Score (DAS) remission (<1.6) at week 22. 

These patients had on average 6 mos duration for their arthritis and 6-11 yrs duration for their psoriasis.  The baseline DAS28-CRP was  a mean of 2.4 and they had an average of 10 tender joints and 5-7 swollen joints at entry.

At week 22, DAS < 1.6 (remission) was achieved by 81% in the TNFi+MTX arm versus 42 % in the MTX only arm (p=0.004). 

The difference was evident at week 8. At week 22 other secondary responses were significantly better including MDA, ACR20/50/70, disease measures and patient-reported outcomes.

Adverse events were similar in both arms. 

Early initiation of TNFi appears to be highly effective in early PsA patients.

The author has no conflicts of interest to disclose related to this subject

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