ACR 2020 | Daily Highlights

MTX optimization versus adding adalimumab

MAINTENANCE OR ACHIEVEMENT OF MINIMAL DISEASE ACTIVITY FOLLOWING THERAPY OPTIMIZATION WITH ADALIMUMAB OR METHOTREXATE IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM PART 2 OF A RAN-DOMIZED, OPEN-LABEL PHASE 4 STUDY

Abstract: 0508
Authors: Philip Mease et al.

» zum Abstract

Key content:
In this open-label study patients with psoriatic arthritis and an inadequate response to MTX 15mg/week (≥ 4 weeks) had been randomized to either adalimumab 40mg every other week and continue MTX 15mg/week (n = 123) or to dose escalate MTX up to 20–25mg (or highest possible dose) (n = 122) for 16 weeks. Minimal disease activity (MDA) at week 16 as the primary endpoint was observed significantly more frequent in patients who received the combination of ADA + MTX (42%) in comparison to the MTX dose escalation group (13%).

This abstract presents data from the second part of this trial (week 16 until week 32), where different strategies were applied:

• Patients who had achieved an MDA response on ADA + MTX now stopped MTX and continued on ADA: 80% maintained the MDA state at the end of part 2
• Patients who did not achieve an MDA response on ADA + MTX were escalated to ADA 40mg every week and MTX 15mg/week, of these, 30% achieved an MDA response
• Patients with an MDA response on escalated MTX, escalated MTX was continued-of these, 67% maintained their MDA response throughout part 2 of the study
• Patients who did not have an MDA response at week 16 received ADA 40mg eow and continued MTX at the highest tolerated dose: 55% achieved an MDA response

Relevance:
Optimization of treatment in patients with active PsA despite being on MTX 15mg is possible by either increasing the dose of MTX or adding a biological. This study is a strategic trial showing that the addition of adalimumab resulted in a significantly higher proportion of patients achieving MDA after 16 weeks but could also show that once MDA is achieved, the minimal disease state is maintained by the majority of patients who continue or decrease the intensity of treatment. Interestingly, an increase in dose (to adalimumab every week instead of every other week) in patients who did not achieve an MDA response with adalimumab every other week was of modest effectiveness and indicates that switching to a biologic with a different mode of action or to a JAK inhibitor might be more efficacious.

Zusammenfassung und Kommentar von:
Prof. Dr. Andrea Rubbert-Roth
St. Gallen