Study Evaluates Etanercept and Methotrexate Alone and in Combination to Treat Psoriatic Arthritis

In a recent phase 3, randomized controlled, double-blind international study, researchers assessed the effectiveness of methotrexate (MTX) and etanercept (ETN) by themselves and in combination in psoriatic arthritis (PsA) patients. 

The findings, presented at the 2018 ACR/ARHP Annual Meeting, concluded that etanercept monotherapy and in combination with methotrexate were both more effective treatment options compared with MTX on its own, and the addition of MTX to ETN did not improve efficacy compared with standalone ETN. 

Patients considered to have active PsA (n = 851; mean age, 48.4 years; median PsA duration, 0.6 years) based on the Classification Criteria for Psoriatic Arthritis were classified into three groups: ETN 50 mg plus MTX 20 mg weekly (combo, n = 283), ETN 50 mg plus oral placebo weekly (ETN-mono, n = 284), and MTX 20 mg plus injectable placebo weekly (MTX-mono, n = 284). The study’s primary endpoint was American College of Rheumatology (ACR)20 response at week 24. Other endpoints included Minimal Disease Activity (MDA) response after 24 weeks, other measures of inflammatory arthritis, radiographic progression, severity of non-articular disease manifestations, and patient-reported outcomes. 

At week 24, ETN-mono patients had significantly greater ACR20 and MDA response rates when compared with MTX-mono patients (ACR20: 60.9% vs 50.7% [P = 0.029]; MDA: 35.9% vs 22.9% [P = 0.005]), as did the combo group compared with the MTX-mono cohort (ACR20: 65.0% vs 50.7% [= 0.005]; MDA: 35.7% vs 22.9% [P = 0.005]). By week 48, the combo and ETN-mono groups showed less radiographic progression than the MTX-mono patients. Outcomes for combo and ETN-mono patients were similar, the researchers noted, with some skin outcome variations. 

“This is the first head-to-head comparison of MTX and a TNFi to address fundamental questions in the treatment of PsA,” the researchers wrote, adding, “These results support the use of ETN as monotherapy for PsA.” 

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Source: American College of Rheumatology