Maintenance of remission possible with methotrexate monotherapy in some PsA patients
medwireNews: Follow-up results from a randomized controlled trial suggest that around half of psoriatic arthritis (PsA) patients who achieve remission through early treatment with a tumor necrosis factor (TNF) inhibitor plus methotrexate remain in remission when switched to methotrexate alone.
However, Marleen van de Sande (University of Amsterdam, the Netherlands) and colleagues caution that “a fair number of patients” who achieved remission with the combination experienced an increase in disease activity after discontinuing their TNF inhibitor, indicating that the early combination treatment strategy “did not provide the ‘window of opportunity’ to change the disease course in all patients.”
The researchers explain that the main results of the double-blind trial, reported previously by medwireNews, demonstrated that early PsA patients initiating treatment with the TNF inhibitor golimumab together with methotrexate were almost twice as likely to achieve remission (DAS-CRP <1.6) at 22 weeks as those given methotrexate alone.
In the follow-up study, the 18 patients who achieved remission on golimumab–methotrexate combination therapy and the eight who achieved remission with methotrexate alone at week 22 were all switched to methotrexate monotherapy for a further 28 weeks, and rates of remission were reassessed at 50 weeks.
van de Sande and team found that 55.6% of those initially achieving remission with combination therapy remained in remission at the 50-week follow-up, as did 75.0% of those given methotrexate monotherapy throughout the study.
When the researchers considered the total study population from the trial, 38.5% of the 26 patients originally given the combination therapy and 25.0% of the 24 patients given methotrexate monotherapy were in remission at week 50.
These findings indicate that “it is possible to maintain remission on [methotrexate] monotherapy in a substantial number of patients with early PsA achieving remission by initial combination treatment with TNF [inhibitors] and methotrexate,” write van de Sande et al in Arthritis Research & Therapy.
“However, for how long this remission can be maintained and whether the maintained remission in these patients is due to an immune reset or merely due to suppression of inflammation is not known,” they add.
The team cautions that their study had a number of limitations, including small patient numbers and inability to assess rates of drug-free remission.
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