Methotrexate Yields No Added Benefit in Etanercept Treated Psoriatic Arthritis Patients Save

Despite a paucity of clinical trial proof, methotrexate is often advocated or mandated to treat psoriatic arthritis.  A recent comparison of clinical trials outcomes fails to show any added value when MTX is given to PsA patients taking etanercept.

Combe et al compared the outcomes of two etanercept trials in psoriatic arthritis. In one trial, patients with PsA received ETN alone (n = 322) and in a second trial (PRESTA study) PsA patients received ETN combined with methotrexate (MTX; n = 152) for 24 weeks. Both trials were placebo-controlled and performed in PsA patients not responding to MTX. 

The 24-week outcomes for both studies, the PsA Response Criteria (PsARC) (80% and 83%) and ACR20 (both 70%), were the same.  Similar equivalent results were shown with ACR50 (55% vs 48%) and ACR70 (35% vs 27%) outcomes, DAS28, CRP, PASI and functional outcomes. 

The authors conclude that ETN is effective in PsA but that MTX offers no additional improvement. Their findings are at odds with RA trials and RA guidelines that support the added value of MTX and TNF inhibitor therapy. However, their findings are consistent with systematic reviews of PsA trials and registries showing similar responses between anti-TNF monotherapy and when MTX is added PsA management.