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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.