Anti-TNF Agents Eased Pain of Psoriatic Arthritis Better Than Did Methotrexate

Treatment with tumor necrosis factor-blocking agents is more effective than methotrexate monotherapy at easing pain and fatigue in patients with psoriatic arthritis and in improving their general health when used in daily clinical practice, according to investigators of an ongoing longitudinal, observational study in Norway.

In a report of 6-month results, investigators said that 526 patients with psoriatic arthritis improved regardless of whether they received methotrexate (MTX) monotherapy or TNF-blocking agents, but “the improvement was larger with TNF-inhibitors.” Assessments were made using numerous measures of disease activity and health-related quality of life (Ann. Rheum. Dis. 2007 Jan. 9 [Epub doi:10.1136/ard.2006. 064808]).

The patients were part of a larger Norwegian registry—the NOR-DMARD Register—in which five Norwegian rheumatology departments consecutively register all their patients with inflammatory arthropathies, said Dr. M.S. Heiberg, of the department of rheumatology in Diakonhjemmet Hospital in Oslo, Norway, and fellow associates.

The patients had a mean age of 48 years and mean disease duration of 7 years. Almost 50% were females; 35% had erosive disease.

Of the 526 patients, 380 received MTX monotherapy and 146 received the TNF-blocking agents infliximab, etanercept, and adalimumab. Of those receiving anti-TNF therapy, 75% of those on infliximab, 60% of those on etanercept, and 79% of those on adalimumab received comcomitant MTX. Patients receiving anti-TNF therapy generally had more active and severe disease.

In assessing the clinical improvement, adjustments were made for age, gender, number of previous disease-modifying antirheumatic drugs, the presence of erosive disease, the treatment center, and the investigator's global assessment, the investigators said.

The adjusted changes at 3 and 6 months were significantly larger in the anti-TNF group for the following assessments: erythrocyte sedimentation rate, Disease Activity Score-28, a shortened version of the health assessment question (M-HAQ), fatigue and global disease activity on a visual analog scale, and four out of eight dimensions on the Short Form-36 health survey (bodily pain, vitality, role physical, and general health).

For instance, SF-36 scores for bodily pain rose by about 18 in the anti-TNF group and by 10 in the MTX group, while scores for general health rose by 7 and 2, respectively. (Scores are computed with a value from 0 to 100, with 100 being the best possible health state.)

Whether concomitant MTX was given in conjunction with anti-TNF therapy made little difference, a subanalysis showed. Improvements in the measures were similar between the subgroups of anti-TNF therapy.

More studies are needed to further establish the role of traditional drugs, they said.

Treatment with tumor necrosis factor-blocking agents is more effective than methotrexate monotherapy at easing pain and fatigue in patients with psoriatic arthritis and in improving their general health when used in daily clinical practice, according to investigators of an ongoing longitudinal, observational study in Norway.

In a report of 6-month results, investigators said that 526 patients with psoriatic arthritis improved regardless of whether they received methotrexate (MTX) monotherapy or TNF-blocking agents, but “the improvement was larger with TNF-inhibitors.” Assessments were made using numerous measures of disease activity and health-related quality of life (Ann. Rheum. Dis. 2007 Jan. 9 [Epub doi:10.1136/ard.2006. 064808]).

The patients were part of a larger Norwegian registry—the NOR-DMARD Register—in which five Norwegian rheumatology departments consecutively register all their patients with inflammatory arthropathies, said Dr. M.S. Heiberg, of the department of rheumatology in Diakonhjemmet Hospital in Oslo, Norway, and fellow associates.

The patients had a mean age of 48 years and mean disease duration of 7 years. Almost 50% were females; 35% had erosive disease.

Of the 526 patients, 380 received MTX monotherapy and 146 received the TNF-blocking agents infliximab, etanercept, and adalimumab. Of those receiving anti-TNF therapy, 75% of those on infliximab, 60% of those on etanercept, and 79% of those on adalimumab received comcomitant MTX. Patients receiving anti-TNF therapy generally had more active and severe disease.

In assessing the clinical improvement, adjustments were made for age, gender, number of previous disease-modifying antirheumatic drugs, the presence of erosive disease, the treatment center, and the investigator's global assessment, the investigators said.

The adjusted changes at 3 and 6 months were significantly larger in the anti-TNF group for the following assessments: erythrocyte sedimentation rate, Disease Activity Score-28, a shortened version of the health assessment question (M-HAQ), fatigue and global disease activity on a visual analog scale, and four out of eight dimensions on the Short Form-36 health survey (bodily pain, vitality, role physical, and general health).

For instance, SF-36 scores for bodily pain rose by about 18 in the anti-TNF group and by 10 in the MTX group, while scores for general health rose by 7 and 2, respectively. (Scores are computed with a value from 0 to 100, with 100 being the best possible health state.)

Whether concomitant MTX was given in conjunction with anti-TNF therapy made little difference, a subanalysis showed. Improvements in the measures were similar between the subgroups of anti-TNF therapy.

More studies are needed to further establish the role of traditional drugs, they said.

Treatment with tumor necrosis factor-blocking agents is more effective than methotrexate monotherapy at easing pain and fatigue in patients with psoriatic arthritis and in improving their general health when used in daily clinical practice, according to investigators of an ongoing longitudinal, observational study in Norway.

In a report of 6-month results, investigators said that 526 patients with psoriatic arthritis improved regardless of whether they received methotrexate (MTX) monotherapy or TNF-blocking agents, but “the improvement was larger with TNF-inhibitors.” Assessments were made using numerous measures of disease activity and health-related quality of life (Ann. Rheum. Dis. 2007 Jan. 9 [Epub doi:10.1136/ard.2006. 064808]).

The patients were part of a larger Norwegian registry—the NOR-DMARD Register—in which five Norwegian rheumatology departments consecutively register all their patients with inflammatory arthropathies, said Dr. M.S. Heiberg, of the department of rheumatology in Diakonhjemmet Hospital in Oslo, Norway, and fellow associates.

The patients had a mean age of 48 years and mean disease duration of 7 years. Almost 50% were females; 35% had erosive disease.

Of the 526 patients, 380 received MTX monotherapy and 146 received the TNF-blocking agents infliximab, etanercept, and adalimumab. Of those receiving anti-TNF therapy, 75% of those on infliximab, 60% of those on etanercept, and 79% of those on adalimumab received comcomitant MTX. Patients receiving anti-TNF therapy generally had more active and severe disease.

In assessing the clinical improvement, adjustments were made for age, gender, number of previous disease-modifying antirheumatic drugs, the presence of erosive disease, the treatment center, and the investigator's global assessment, the investigators said.

The adjusted changes at 3 and 6 months were significantly larger in the anti-TNF group for the following assessments: erythrocyte sedimentation rate, Disease Activity Score-28, a shortened version of the health assessment question (M-HAQ), fatigue and global disease activity on a visual analog scale, and four out of eight dimensions on the Short Form-36 health survey (bodily pain, vitality, role physical, and general health).

For instance, SF-36 scores for bodily pain rose by about 18 in the anti-TNF group and by 10 in the MTX group, while scores for general health rose by 7 and 2, respectively. (Scores are computed with a value from 0 to 100, with 100 being the best possible health state.)

Whether concomitant MTX was given in conjunction with anti-TNF therapy made little difference, a subanalysis showed. Improvements in the measures were similar between the subgroups of anti-TNF therapy.

More studies are needed to further establish the role of traditional drugs, they said.