DMARD number, disease duration influence treatment outcomes in rheumatoid arthritis
The previous use of multiple disease-modifying antirheumatic drugs (DMARDs) and disease duration appear to affect treatment outcomes in rheumatoid arthritis (RA) patients initiating adalimumab therapy, according to a posthoc analysis of two randomized controlled trials.
The analysis included 207 patients from DE019 and 67 patients from ARMADA who were treated with adalimumab plus methotrexate (MTX). Treatment response was evaluated at week 24 using the following outcomes: 28-joint Disease Activity Score based on C-reactive protein (DAS28[CRP]), Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire Disability Index (HAQ-DI), and 20%/50%/70% improvement in American College of Rheumatology (ACR) responses.
Disease duration was ≤1 year for nine patients (4.3 percent), >1 to 5 years for 62 (30.0 percent), >5 to 10 years for 43 (20.8 percent) and >10 years for 93 (44.9 percent) in the DE019 cohort; and ≤5 years for 51 patients (76.1 percent) and >5 to 10 years for 16 (23.9 percent) in the ARMADA cohort. With respect to prior use of DMARDs, 75, 62 and 70 patients in DE019 used MTX plus 0–1, 2 and >2 DMARDs, respectively. The corresponding numbers of patients in ARMADA were 41, 13 and 13.
In DE019, a greater number of prior DMARDs (>2 vs 0–1) were linked to nominal improvements in DAS28(CRP) (–1.8 vs –2.2), SDAI (–22.1 vs –26.9) and HAQ-DI (–0.43 vs –0.64) at week 24. RA duration of >10 years vs <1 year was associated with higher HAQ-DI scores (1.1 vs 0.7) at week 24, but results for DAS28(CRP) and SDAI were mixed. A greater number of prior DMARDs and longer RA duration were both associated with lower ACR response rates at week 24.
The findings were consistent in ARMADA.
Taken together, the present data support recommendations to initiate without delay combination therapy with a biologic agent and MTX in patients with inadequate response to MTX monotherapy, the researchers said.