March 13, 2016
MAUI, HAWAII – The effectiveness of methotrexate in psoriatic arthritis is a matter of debate, but Dr. Arthur Kavanaugh is a believer based in part upon a recent subanalysis of the TICOPA study.
Moreover, his new 5-year follow-up analysis from the GO-REVEAL study of golimumab (Simponi) with or without concomitant methotrexate suggests that methotrexate plus the tumor necrosis factor inhibitor provided synergistic efficacy, he said at the 2016 Rheumatology Winter Clinical Symposium.
The 5-year analysis doesn’t provide definitive proof of synergistic benefit because it wasn’t designed or powered with that endpoint in mind (Arthritis Care Res. 2016;68:267–74). No randomized trial completed to date has been. But the first-ever trial set up to test the synergistic efficacy hypothesis is underway. It’s a 52-week, double-blind, multicenter, randomized trial of etanercept (Enbrel) and methotrexate versus either alone in combination with placebo. And while the Amgen-sponsored study won’t be completed until 2018, Dr. Kavanaugh is ready to predict the outcome based in part upon the message contained in his GO-REVEAL findings.
Arthritis Care & Research
Volume 67, Issue 12, pages 1656–1663, December 2015
Machaon Bonafede et al.
To estimate adherence and persistence with etanercept plus methotrexate (ETN-MTX) combination therapy and MTX, hydroxychloroquine, and sulfasalazine triple therapy at 1 year following treatment initiation in adults with rheumatoid arthritis (RA).
This retrospective analysis used data from the Truven Health MarketScan Commercial and Medicare Supplemental databases from January 2009 to July 2013. Adherence was defined as having percentage of days covered >80% for all drugs within each regimen. Persistence was defined as no treatment gap >45 days for any drug and no addition or switching to other disease-modifying antirheumatic drugs. Multiple logistic regression models were employed in the analyses to control for potential confounders.
By: AMY KARON, Rheumatology News Digital Network SEPTEMBER 18, 2015
Key clinical point: Use of methotrexate increased the risk of hepatic enzyme abnormalities but not serious liver-related events among patients with inflammatory diseases.
Major finding: Methotrexate use approximately doubled the risk of any adverse liver event (RR, 2.19) but did not increase the risk of cirrhosis, liver failure, or liver-related death.
Data source: A meta-analysis of 32 randomized, controlled trials of methotrexate in rheumatoid arthritis, psoriasis, psoriatic arthritis, and inflammatory bowel disease.
Disclosures: The investigators reported no funding sources or conflicts of interest.
Biologics: Targets and Therapy
Detert J, Klaus P Published Date May 2015 Volume 2015:9 Pages 35—43 DOI http://dx.doi.org/10.2147/BTT.S53361
Jacqueline Detert, Pascal Klaus
Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
Abstract: Biologics, possibly in combination with a conventional disease-modifying antirheumatic drug (DMARD) – preferably methotrexate (MTX), are used in accordance with the recommendations of the international rheumatological societies. However, in clinical practice, this recommendation is often problematic, as many rheumatologists know from personal experience. The quality of life of the patient is affected mainly by drug-induced intolerances (eg, MTX). Thus, the acceptance of the patient to treatment is often so inadequate that a discontinuation of the drug is necessary. In daily practice, approximately 30% of patients with biological therapy receive no concomitant DMARD according to the register data.
Keywords: efficacy, safety, methotrexate, autoimmune disease
In early rheumatoid arthritis (RA), treatment with the antimalarial hydroxychloroquine may reduce the risk of hyperlipidemia, when compared with methotrexate (MTX), according to a large retrospective study from Brigham and Women’s Hospital, Boston.
The study of disease-modifying antirheumatic drug (DMARD) use also noted a possible increase in hyperlipidemia risk in some initiating treatment with tumor necrosis factor alpha (TNF alpha inhibitors). The investigation was led by Rishi J. Desai, PhD, a postdoctoral research fellow in the hospital’s Division of Pharmacoepidemiology and Pharmacoeconomics.
Although RA patients have a generally higher risk of cardiovascular disease (CVD), several studies have suggested that RA patients may have lower total and low-density lipoprotein (LDL) cholesterol than persons without RA. “Reports of inverse association between inflammatory markers and lipid parameters may explain this phenomenon,” Desai and associates wrote.