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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

: Behrens, F.; Meier, L.; Prinz, J.C.; Jobst, J.; Lippe, R.; Löschmann, P.-A.; Lorenz, H.-M.


The Journal of Rheumatology 45 (2018), No.6, pp.802-810
ISSN: 0315-162X
Journal Article
Fraunhofer IME ()

Objective. To evaluate patients with psoriatic arthritis (PsA) receiving etanercept (ETN) monotherapy or ETN plus conventional synthetic disease-modifying antirheumatic drugs (csDMARD) to determine the proportion achieving a clinically meaningful response in arthritis, psoriasis, and quality of life simultaneously.
Methods. A prospective, multicenter, 52-week observational study in patients with active PsA evaluated treatment with ETN in clinical practice ( NCT00293722). This analysis assessed simultaneous achievement of 3 treatment targets: low disease activity (LDA) based on 28-joint count Disease Activity Score (DAS28); body surface area (BSA) involvement = 3%; and a score > 45 on the Medical Outcomes Study Short Form-12 (SF-12) physical component summary.
Results. Of 579 patients, 380 received ETN monotherapy and 199 received combination ETN plus csDMARD. At 52 weeks, data for all 3 disease domains were available for 251 patients receiving monotherapy and 151 receiving combination therapy. In the monotherapy and combination therapy groups, 61 (24.3%) and 37 (24.5%) patients, respectively, achieved all 3 treatment targets simultaneously. A significantly greater proportion of patients receiving monotherapy versus combination therapy achieved SF-12 > 45 (43.0% vs 31.8%; p < 0.05) and DAS28 LDA (72.5% vs 62.3%; p < 0.05). Conversely, BSA = 3% was reached by a significantly greater proportion receiving combination therapy (75.5% vs 56.6%; p < 0.001). However, baseline BSA involvement was higher for the monotherapy group.
Conclusion. While nearly half the patients achieved arthritis and psoriasis treatment targets simultaneously and one-fourth reached all 3 treatment targets, combining ETN and csDMARD did not substantially improve clinical response compared with ETN monotherapy in this real-world PsA patient population.