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 Orthopedics

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

Most Popular Orthopedics Articles

1 Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial BMJ, August 1, 2014    Clinical Article

2 A randomized trial of epidural glucocorticoid injections for spinal stenosis New England Journal of Medicine, July 7, 2014    Evidence Based Medicine    Clinical Article

3 Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study European Journal of Physical and Rehabilitation Medicine, August 4, 2014    Clinical Article

4 A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement The Bone & Joint Journal, August 6, 2014    Review Article    Clinical Article

5 Non-steroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: A systematic review and meta-analysis Archives of Physical Medicine and Rehabilitation, May 19, 2014    Evidence Based Medicine    Review Article    Clinical Article

6 Effective treatment of posttraumatic and postoperative edema in patients with ankle and hindfoot fractures: A randomized controlled trial comparing multilayer compression therapy and intermittent impulse compression with the standard treatment with ice The Journal of Bone & Joint Surgery, August 18, 2014    Evidence Based Medicine    Clinical Article

7 Denosumab rapidly increases cortical bone in key locations of the femur: A 3D bone mapping study in women with osteoporosis Journal of Bone and Mineral Research, August 5, 2014    Clinical Article

8 What is the best time point to identify patients at risk of developing persistent low back pain? Journal of Back and Musculoskeletal Rehabilitation, August 14, 2014    Clinical Article

9 Is statin use associated with new joint-related symptoms, physical function and quality of life? The Australian Longitudinal Study on Womens Health Arthritis Care & Research , July 8, 2014    Clinical Article

10 Wrist-ankle acupuncture for the treatment of pain symptoms: A systematic review and meta-analysis Full Text Evidence-based Complementary and Alternative Medicine , July 18, 2014    Free full text    Evidence Based Medicine    Review Article    Clinical Article

11 The bidirectional relationship between pain intensity and sleep disturbance/quality in patients with low back pain The Clinical Journal of Pain, August 7, 2014    Clinical Article

12 45-day mortality after 467 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study The Lancet, July 25, 2014    Evidence Based Medicine    Clinical Article

13 Association between forearm muscle thickness and age-related loss of skeletal muscle mass, handgrip and knee extension strength and walking performance in old men and women: A pilot study Ultrasound in Medicine and Biology, August 27, 2014    Clinical Article

14 Accountability and empathy effects on medical students clinical judgments in a disability determination context for low back pain The Journal of Pain, August 25, 2014    Clinical Article

15 Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: Influences of age, gender and osteoarthritis affecting other joints Annals of Rheumatic Diseases, August 8, 2014    Clinical Article

16 Combined glucosamine and chondroitin sulfate, once or three times daily, provides clinically relevant analgesia in knee osteoarthritis Clinical Rheumatology, August 12, 2014    Clinical Article

17 New tool could drastically reduce the number of potential future hip fractures The University of Manchester News, August 14, 2014

18 Hamstring autograft versus soft-tissue allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials Arthroscopy, August 8, 2014    Evidence Based Medicine    Review Article

19 Comparison of three knee braces in the treatment of medial knee osteoarthritis The Knee, August 1, 2014    Clinical Article

20 Sarilumab, a fully human monoclonal antibody against IL-6R{alpha} in patients with rheumatoid arthritis and an inadequate response to methotrexate: Efficacy and safety results from the randomised SARIL-RA-MOBILITY Part A trial Annals of Rheumatic Diseases, August 12, 2014    Clinical Article

Indexed Journals in Orthopedics: Journal of Bone and Joint Surgery, Journal of Arthroplasty, Spine, The Kneemore

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