Baseline Disease Activity Predicts Methotrexate Response in Early RA

In patients with early rheumatoid arthritis (RA), baseline disease characteristics and early disease activity can predict response to methotrexate treatment and radiographic progression at 6 months, according to study results published in the Annals of the Rheumatic Diseases.

In addition, the results indicated that adding adalimumab at 6 months after methotrexate treatment failure can improve outcomes.

The researchers performed a post hoc analysis of the OPTIMA and PREMIER studies of patients with RA for <1 and <3 years, respectively (ClinicalTrials.gov identifiers: NCT00420927, NCT00195663). This analysis examined the efficacy of methotrexate and adalimumab in methotrexate-naive participants.

The study included participants who did not respond to methotrexate monotherapy after 6 months. In the OPTIMA study, adalimumab was added to therapy after insufficient treatment response; in the PREMIER study, participants continued on methotrexate. Both studies assessed clinical, functional, and radiologic outcomes after 1 year. The researchers looked at demographics, baseline disease characteristics, and time-averaged disease variables over a 12-week interval to determine if any were predictors of insufficient response and clinically relevant radiographic progression (CRRP).

The researchers found that the baseline 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP) and time-averaged DAS28-CRP over 4, 8, and 12 weeks were the strongest predictors of insufficient response to methotrexate and CRRP.

The results also indicated that adding adalimumab to methotrexate therapy was associated with better clinical, functional, and radiographic outcomes after 1 year compared with continuing methotrexate therapy alone.

“These results support, and indirectly confirm, treatment-to-target strategies and timely adaptation of therapy with [tumor necrosis factor] inhibitors in patients with early RA and identify risk factors of patients who are not responding sufficiently to methotrexate,” the researchers wrote.

The OPTIMA and PREMIER studies and this post hoc analysis were funded by AbbVie.

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Reference

Smolen JS, van Vollenhoven RF, Florentinus S, et al. Predictors of disease activity and structural progression after treatment with adalimumab plus methotrexate or continued methotrexate monotherapy in patients with early rheumatoid arthritis and suboptimal response to methotrexate [published online August 3, 2018]. Ann Rhem Dis. doi:10.1136/annrheumdis-2018-213502