Session Type: Abstract Submissions (ACR)
Background/Purpose: To achieve comprehensive disease control (CDC; defined as simultaneous achievement of DAS28 < 3.2, HAQ-DI < 0.5 and ΔmTSS ≤ 0.5) or comprehensive disease remission (CDR; defined as simultaneous achievement of DAS28 < 2.6, HAQ-DI < 0.5 and ΔmTSS ≤ 0.5) is our therapeutic goal of treating RA. Owing to 2010 ACR/EULAR recommendation for early treatment of RA (Aletaha D et al, Ann Rheum Dis 69:1580, 2010), we found, in line with the finding of O’Dell et al. (Arthritis Rheum 65:1985, 2013), that 69/137 (50.4%) of RA patients given low-dose methotrexate (MTX) monotherapy showed no radiographic progression over 3 years when the patients were treated continuously with MTX monotherapy until significant adverse events or radiographic progressions were suspected. However, it remains unclear if the CDC and/or CDR are comparable between the patients treated with MTX monotherapy and those with MTX plus biologics. We here compared the clinical efficacy of MTX monotherapy and adalimumab (ADA) + MTX: 161 patients who showed adequate responses to methotrexate (MTX) (MTX group) were compared with 96 patients treated with ADA + MTX for inadequate response to MTX (MTX-IR) (ADA group) as to the effects on functional and structural outcomes for 3 years.
Methods: Grip strength, CDR and CDC rates and patients’ proportions with structural remission (ΔmTSS ≤ 0.5), clinical relevant radiographic progression (CRRP; ΔmTSS >3) and rapid radiographic progression (RRP; ΔmTSS>5) were measured in MTX group (n=161, mean disease duration: 4.4 years) or ADA group (n=96, mean disease duration: 8.5 years) every year for 3 years.
Results: There was no significant difference in clinical remission rates (DAS28-ESR<2.6) between MTX and ADA groups at 3 years (LOCF). While, CDR rates for 3 years were much higher in ADA group (43.2%) than MTX group (18.3%) as well as those of CDC (45.9% vs. 24.0%, respectively). Moreover, about the structural change, ratios of patients with RRP were decreased in both MTX and ADA group at 3 years compared to the status at first year, however the ratio of patients with RRP in MTX group was 10% whereas that of patients with RRP in ADA group was 3%. Reflecting this result about the structural change, grip strength in ADA group was improved every year, but that was gradually decreased in MTX group after 1 year, even the baseline grip strength in MTX group was much stronger than that in ADA group143 vs. 177 mmHg, p=0.0001.
Conclusion: It was demonstrated that grip strength gradually decreased from 1 year after the initiation of MTX treatment in the patients with MTX monotherapy, while ADA treatment to MTX-IR patients improved grip strength in a time dependent manner, which was supported by significantly better CDC and CDR rates over 3 years in the ADA group than those in the MTX group. Thus, the treatment in combination with biologics seems preferable for the patients with increased disease activity in face of MTX monotherapy.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/good-response-to-methotrexate-mtx-andor-mtx-plus-adallimumab-ada-3-yrs-study-results-in-patients-with-rheumatoid-arthritis-ra/