Clinical, functional and radiographic consequences of achieving stable low disease activity and remission with adalimumab plus methotrexate or methotrexate alone in early rheumatoid arthritis: 26-week results from the randomised, controlled OPTIMA study
Annals of Rheumatic Diseases,  Clinical Article

Kavanaugh A et al. – Treatment with adalimumab plus methotrexate (ADA+MTX) was significantly superior to methotrexate alone with respect to clinical, radiographic and functional outcomes in patients with early active rheumatoid arthritis (RA). Before initiating treatment with adalimumab, individual patient evaluation of the benefit/risk ratio should be carefully considered.

Methods
  • 1032 patients with active RA were randomly assigned 1:1 to ADA+MTX or placebo plus methotrexate (PBO+MTX) for 26 weeks.
  • Treatment modifications were to be made in a subsequent study period based on the achievement of DAS28(CRP) <3.2 at weeks 22 and 26.
  • Post–hoc analyses compared patients achieving stable remission using DAS28 and 2010 ACR/EULAR criteria with those achieving LDA but not remission.

Results
  • Among patients completing 6 months, 44% (207/466) ADA+MTX versus 24% (112/460) PBO+MTX patients achieved stable LDA at weeks 22 and 26 (p<0.001).
  • Combination therapy was statistically superior to methotrexate in obtaining higher ACR20/50/70 responses, more clinical remissions, greater mean reductions in DAS28(CRP), no radiographic progression, and normal functional status at week 26 (p<0.001 for all).
  • The only factor predicting stable LDA was disease activity at week 12.
  • Patients achieving ACR/EULAR remission, particularly in the PBO+MTX group, had some advantage in radiographic outcomes compared with patients who only achieved LDA (but not remission).
  • The overall frequency of adverse events was comparable between groups.
  • There were more serious infections and deaths in the ADA+MTX group, with a possible age effect.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Internal Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Internal Medicine Articles

1 Statins and physical activity in older men the osteoporotic fractures in men study JAMA Internal Medicine, June 12, 2014    Evidence Based Medicine    Clinical Article

2 Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials BMJ, June 11, 2014    Evidence Based Medicine    Clinical Article

3 CPAP, weight loss, or both for obstructive sleep apnea New England Journal of Medicine, June 13, 2014    Evidence Based Medicine    Clinical Article

4 Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: A meta-analysis JAMA, June 26, 2014    Evidence Based Medicine    Clinical Article

5 Avoidance of sun exposure is a risk factor for all-cause mortality: results from the MISS cohort Journal of Internal Medicine, April 22, 2014    Evidence Based Medicine    Clinical Article

6 Outpatient antibiotic prescribing in the United States: 2000 to 2010 Full Text BMC Medicine, June 19, 2014    Free full text    Evidence Based Medicine    Clinical Article

7 Efficacy and safety of nebivolol and valsartan as fixed-dose combination in hypertension: a randomised, multicentre study The Lancet, May 30, 2014    Evidence Based Medicine    Clinical Article

8 Enzalutamide in metastatic prostate cancer before chemotherapy New England Journal of Medicine, June 3, 2014    Evidence Based Medicine    Clinical Article

9 Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry BMJ, June 10, 2014    Evidence Based Medicine    Clinical Article

10 HIV infection: epidemiology, pathogenesis, treatment, and prevention The Lancet, June 5, 2014    Evidence Based Medicine    Clinical Article

11 Cryptogenic stroke and underlying atrial fibrillation New England Journal of Medicine, June 27, 2014    Evidence Based Medicine    Clinical Article

12 Resveratrol levels and all-cause mortality in older community-dwelling adults JAMA Internal Medicine, May 13, 2014    Evidence Based Medicine    Clinical Article

13 Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson's disease (PD MED): a large, open-label, pragmatic randomised trial The Lancet, June 18, 2014    Evidence Based Medicine    Clinical Article

14 Outpatient glycemic control with a bionic pancreas in type 1 diabetes New England Journal of Medicine, June 20, 2014    Evidence Based Medicine    Clinical Article

15 Rosuvastatin for sepsis-associated acute respiratory distress syndrome New England Journal of Medicine, May 20, 2014    Evidence Based Medicine    Clinical Article

16 Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications JAMA, June 17, 2014    Evidence Based Medicine    Clinical Article

17 5{alpha}-reductase inhibitors and risk of high-grade or lethal prostate cancer JAMA Internal Medicine, June 3, 2014    Evidence Based Medicine    Clinical Article

18 Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials BMJ, June 9, 2014    Evidence Based Medicine    Clinical Article

19 Fracture prediction after discontinuation of 4 to 5 years of alendronate therapy: The FLEX study JAMA Internal Medicine, May 7, 2014    Evidence Based Medicine    Clinical Article

20 Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia JAMA, June 4, 2014    Evidence Based Medicine    Clinical Article

Indexed Journals in Internal Medicine: New England Journal of Medicine, The Lancet, Archives of Internal Medicinemore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close