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Clinical and radiological dissociation of anti-TNF plus methotrexate treatment in early rheumatoid arthritis in routine care: results from the ABRAB study.

Juhász P, Mester A, Biró AJ, Héjj G, Poór G - BMC Musculoskelet Disord (2014)

Bottom Line: Disease activity was decreased and functional status was improved significantly in both groups.In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A.Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. poor.gyula@orfi.hu.

ABSTRACT

Background: Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Anti-tumour necrosis factor (anti-TNF) drugs can halt radiological progression better than conventional DMARDs even in clinical non-responders.

Methods: The efficacy of anti-TNF plus methotrexate (MTX) treatment versus MTX monotherapy on clinical and radiological outcomes were compared in early rheumatoid arthritis (RA) patients in clinical practice by retrospective analysis of an observational cohort.49 early RA patients (group A) on first-line MTX monotherapy and 35 early RA patients (group B) on anti-TNF plus MTX treatment were selected from an observational cohort and evaluated retrospectively focusing on their first twelve months of treatment. Data on disease activity (DAS28) and functional status (HAQ-DI) were collected three monthly. One-yearly radiological progression was calculated according to the van der Heijde modified Sharp method (vdHS). Clinical non-responder patients in both groups were selectively investigated from a radiological point of view.

Results: Disease activity was decreased and functional status was improved significantly in both groups. One-yearly radiological progression was significantly lower in group B than in group A. The percentage of patients showing radiological non-progression or rapid radiological progression demonstrated a significant advantage for group B patients. In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A.

Conclusions: Clinical efficacy within our study was similar for tight-controlled MTX monotherapy as well as for combination treatment with anti-TNF and MTX. However MTX monotherapy was accompanied by more rapid radiological progression and less radiological non-progression. Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.

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Change in radiological progression (vdHS U/year) in group A and group B regarding all, clinical non-responder and clinical responder patients. (All: all patients, Resp: clinical responder patients, Non-resp: clinical non-responder patients).
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Figure 3: Change in radiological progression (vdHS U/year) in group A and group B regarding all, clinical non-responder and clinical responder patients. (All: all patients, Resp: clinical responder patients, Non-resp: clinical non-responder patients).

Mentions: To perform a more detailed evaluation of radiological progression at 12 months patients in both treated groups were divided into subgroups of clinical non-responder and clinical responder patients. A non-significant trend was observable in group A showing that radiological progression was higher in clinical non-responders than in clinical responders when compared to all patients within that group. This suggests the persistant effect of disease activity on radiological progression on MTX monotherapy. In group B we observed no difference in radiological progression at 12 months between responders and non-responders, indicating that anti-TNF + MTX treatment indeed dissociates disease activity and radiological progression (Figure 3).Radiological progression at 12 months and the percentage of patients showing radiological non-progression or rapid radiological progression were separately assessed in the subgroups of clinically non-responder patients. Within these subgroups mean radiological progression was 3.698 (3.837) U/year (95% CI: 2.337-5.058) in group A and 0.7141 (1.26) U/year (95% CI: 0.066-1.362) in group B (p < 0.001, Figure 4). Group B was associated with a higher percentage of patients with radiological non-progression than group A (58.8% vs 12.1% respectively, p < 0.001). We found no significant difference regarding rapid radiological progression, nevertheless group B showed better results than group A in this respect as well (0% vs 21.2% respectively, p = 0.07).


Clinical and radiological dissociation of anti-TNF plus methotrexate treatment in early rheumatoid arthritis in routine care: results from the ABRAB study.

Juhász P, Mester A, Biró AJ, Héjj G, Poór G - BMC Musculoskelet Disord (2014)

Change in radiological progression (vdHS U/year) in group A and group B regarding all, clinical non-responder and clinical responder patients. (All: all patients, Resp: clinical responder patients, Non-resp: clinical non-responder patients).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4114796&req=5

Figure 3: Change in radiological progression (vdHS U/year) in group A and group B regarding all, clinical non-responder and clinical responder patients. (All: all patients, Resp: clinical responder patients, Non-resp: clinical non-responder patients).
Mentions: To perform a more detailed evaluation of radiological progression at 12 months patients in both treated groups were divided into subgroups of clinical non-responder and clinical responder patients. A non-significant trend was observable in group A showing that radiological progression was higher in clinical non-responders than in clinical responders when compared to all patients within that group. This suggests the persistant effect of disease activity on radiological progression on MTX monotherapy. In group B we observed no difference in radiological progression at 12 months between responders and non-responders, indicating that anti-TNF + MTX treatment indeed dissociates disease activity and radiological progression (Figure 3).Radiological progression at 12 months and the percentage of patients showing radiological non-progression or rapid radiological progression were separately assessed in the subgroups of clinically non-responder patients. Within these subgroups mean radiological progression was 3.698 (3.837) U/year (95% CI: 2.337-5.058) in group A and 0.7141 (1.26) U/year (95% CI: 0.066-1.362) in group B (p < 0.001, Figure 4). Group B was associated with a higher percentage of patients with radiological non-progression than group A (58.8% vs 12.1% respectively, p < 0.001). We found no significant difference regarding rapid radiological progression, nevertheless group B showed better results than group A in this respect as well (0% vs 21.2% respectively, p = 0.07).

Bottom Line: Disease activity was decreased and functional status was improved significantly in both groups.In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A.Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. poor.gyula@orfi.hu.

ABSTRACT

Background: Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Anti-tumour necrosis factor (anti-TNF) drugs can halt radiological progression better than conventional DMARDs even in clinical non-responders.

Methods: The efficacy of anti-TNF plus methotrexate (MTX) treatment versus MTX monotherapy on clinical and radiological outcomes were compared in early rheumatoid arthritis (RA) patients in clinical practice by retrospective analysis of an observational cohort.49 early RA patients (group A) on first-line MTX monotherapy and 35 early RA patients (group B) on anti-TNF plus MTX treatment were selected from an observational cohort and evaluated retrospectively focusing on their first twelve months of treatment. Data on disease activity (DAS28) and functional status (HAQ-DI) were collected three monthly. One-yearly radiological progression was calculated according to the van der Heijde modified Sharp method (vdHS). Clinical non-responder patients in both groups were selectively investigated from a radiological point of view.

Results: Disease activity was decreased and functional status was improved significantly in both groups. One-yearly radiological progression was significantly lower in group B than in group A. The percentage of patients showing radiological non-progression or rapid radiological progression demonstrated a significant advantage for group B patients. In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A.

Conclusions: Clinical efficacy within our study was similar for tight-controlled MTX monotherapy as well as for combination treatment with anti-TNF and MTX. However MTX monotherapy was accompanied by more rapid radiological progression and less radiological non-progression. Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.

Show MeSH
Related in: MedlinePlus