Effectiveness of adalimumab in treating patients with active psoriatic arthritis and predictors of good clinical responses for arthritis, skin and nail lesions.

Abstract

OBJECTIVES:

To evaluate the effectiveness of adalimumab in patients with psoriatic arthritis (PsA) and identify predictors of good clinical response for joint and skin lesions.

METHODS:

Patients received adalimumab 40 mg every other week in addition to standard therapy in this prospective, 12-week, open-label, uncontrolled study. Four definitions of good clinical response were used: > or =50% improvement in American College of Rheumatology response criteria (ACR50), good response according to European League Against Rheumatism (EULAR) guidelines, a > or =3-grade improvement in Physician Global Assessment of psoriasis (PGA) and a > or =50% improvement in the Nail Psoriasis Severity Index (NAPSI). Response predictors were determined by logistic regression with backward elimination (selection level was 5%).

RESULTS:

Of 442 patients, 94% completed 12 weeks of treatment. At week 12, 74%, 51% and 32% of the patients had achieved ACR20, 50 and 70, respectively; 87% and 61% experienced moderate and good responses according to EULAR criteria, respectively. The percentage of patients with PGA results of "clear/almost clear" increased from 34% (baseline) to 68%. The mean NAPSI score was reduced by 44%. No new safety signals were detected. A lower Health Assessment Questionnaire Disability Index (HAQ-DI) score, greater pain assessment, male sex and absence of systemic glucocorticoid therapy were strongly associated with achievement of ACR50 and good response according to EULAR criteria. In addition, greater C-reactive protein concentration and polyarthritis predicted ACR50, and non-involvement of large joints predicted a good response according to EULAR criteria.

CONCLUSIONS:

Adalimumab was effective in patients with PsA. Lower impairment of physical function, greater pain, male sex and no systemic treatment with glucocorticoids were factors that increased the chance of achieving a good clinical response.

• Authors: F Van den Bosch, B Manger, P Goupille, N McHugh, E Rødevand, P Holck, R F van Vollenhoven, M Leirisalo-Repo, O Fitzgerald, M Kron, M Frank, S Kary, H Kupper
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 69 Issue 2 Pg. 394-9 (Feb 2010) ISSN: 1468-2060 [Electronic] England
• PMID: 19815494 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Dermatologic Agents
• Adalimumab

Topics

• Adalimumab
• Adult
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents (therapeutic use)
• Arthritis, Psoriatic (drug therapy)
• Dermatologic Agents (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Nail Diseases (drug therapy)
• Prognosis
• Prospective Studies
• Psoriasis (drug therapy)
• Severity of Illness Index
• Treatment Outcome