Treatment with golimumab in psoriatic arthritis (PsA) was associated with improvement in long-term function, patient global assessments, and radiographic outcomes when patients achieved minimal disease activity (MDA), according to results from the Study of the Safety and Efficacy of Golimumab in Patients With Active Psoriatic Arthritis (GO-REVEAL).
GO-REVEAL was a phase 3, randomized, double-blind clinical trial in which participants received placebo for 24 weeks, followed by an open-label extension of golimumab 50/100 mg for up to 5 years. Researchers evaluated long-term outcomes in 405 PsA patients who achieved or did not achieve MDA through 5 years of golimumab treatment.
“The implications of achieving MDA over a longer period have not been explored to date,” the authors wrote in their study, published in Arthritis Care & Research. “Based on patient data collected from the GO-REVEAL study, treatment with golimumab resulted in achievement of MDA in approximately 50% of patients through 5 years.”
Treatment with golimumab resulted in an MDA response rate of 23.5% at 14 weeks, compared with a 1.0% response rate for patients taking the placebo control (P <.0001). The response rates were also significantly higher for patients receiving golimumab vs placebo at 24 weeks (28.1% vs 7.7%; P<.0001) and 52 weeks (42.4% vs 30.2%; P=.037).
The authors noted that radiographic benefit in patients with persistent MDA was more pronounced in patients using methotrexate at baseline.
Approximately 50% of patients taking golimumab achieved MDA at least once. Patients who achieved MDA at ≥3 and ≥4 consecutive visits had significantly less radiographic progression when compared to patients who did not achieve MDA. At 256 weeks, these patients also had significant improvement in components of MDA criteria that allowed for assessment of physical function (Health Assessment Questionnaire disability index [HAQ DI]) and overall disease activity.
Results from logistic regression analyses indicated that a 1-unit higher baseline HAQ DI score decreased the likelihood of achieving MDA at ≥3 (odds ratio [OR]: 0.514; 95% confidence interval [CI], 0.321-0.824; P=.006) and ≥4 consecutive visits (OR: 0.480; 95% CI, 0.290-0.795; P=.004).
Summary and Clinical Applicability
Patients with PsA treated with golimumab over the course of 5 years showed significant improvement in long-term function, global assessment, and radiographic outcome. Aiming for MDA as part of a treat-to-target strategy may result in long-term radiographic and functional benefit.
Kavanaugh A, van der Heijde D, Beutler A, et al. Radiographic progression of patients with psoriatic arthritis who achieve minimal disease activity in reponse to golimumab therapy: results through 5 years of a randomized, placebo-controlled study. Arthritis Care Res. 2016;68(2):267-274. doi: 10.1002/acr.22576.