Etanercept Monotherapy vs Combination Therapy Examined in Psoriatic Arthritis

In patients with psoriatic arthritis (PsA), treatment with etanercept in combination with a conventional synthetic disease-modifying antirheumatic drug (csDMARD) offered no clinical benefit compared with etanercept monotherapy, according to the results of a 52-week, prospective, multicenter, observational study (ClinicalTrials.gov identifier: NCT00293722) published in The Journal of Rheumatology.

The investigators evaluated patients with PsA to determine the proportion who had a clinically meaningful response in arthritis, psoriasis, and quality of life parameters simultaneously. Researchers assessed the simultaneous attainment of the following 3 treatment targets, including low disease activity based on the 28-joint count Disease Activity Score (DAS28), body surface area involvement ≤3%, and a score of >45 on the Medical Outcomes Study Short Form-12 (SF-12) physician component summary.

A total of 579 patients were evaluated; 380 received etanercept monotherapy and 199 received combination therapy with etanercept plus csDMARD therapy. At 52 weeks, data were available for the 3 disease domains in 251 participants in the etanercept monotherapy group and in 151 participants in the combination therapy group. Overall, 24.3% of patients in the etanercept-alone group and 24.5% of patients in the combination therapy group achieved all of the 3 treatment targets simultaneously.

A significantly higher proportion of patients in the monotherapy group vs the combination therapy group attained an SF-12 score >45 (43.0% vs 31.8%; P <.05) and DAS28 low disease activity (72.5% vs 62.3%; P <.05). In contrast, body surface area ≤3% was attained by a significantly higher proportion of patients receiving combination therapy vs monotherapy (75.5% vs 56.6%; P <.001). Baseline body surface area involvement, however, was greater in the monotherapy group.

The investigators concluded that with almost half of the patients achieving arthritis and psoriasis treatment targets simultaneously and approximately one-fourth attaining all 3 treatment targets, combination etanercept plus csDMARD therapy was not associated with a substantially improved clinical response compared with etanercept monotherapy in a real-world population of patients with PsA.

Reference

Behrens F, Meier L, Prinz JC, et al. Simultaneous response in several domains in patients with psoriatic disease treated with etanercept as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs [published online April 1, 2018].  J Rheumatol. doi: 10.3899/jrheum.170932