Rheumatology Medical News about early active rheumatoid arthritis;methotrexate monotherapy;adalimumab

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Evaluation of two strategies (initial methotrexate monotherapy vs its combination with adalimumab) in management of early active rheumatoid arthritis: data from the GUEPARD trial
Rheumatology, 09/11/09

Soubrier M et al. – Initial combination of MTX and ADA and then an adjusted based on the disease activity status achieved a faster control of disease activity but did not increase the number of patients for whom anti-TNF- treatment was not needed after 12 weeks nor a better subsequent clinical or radiological outcome than a 3-month delayed initiation of anti-TNF in patients with still active disease despite MTX.

Methods

Prospective unblinded randomized multicentre controlled 1-year trial in which 65 patients with early (<6 months) and active [disease activity score (DAS28ESR) >5.1] RA were assigned to Group 1 (32 patients): MTX (0.3 mg/kg/week, maximum of 20 mg/week, without escalating dose regimen) or to Group 2 (33 patients): initial combination therapy with MTX (as in Group 1) and ADA (40 mg eow)
In both groups, treatment was adjusted every 3 months

Results

From Week 12 until Week 52, seven patients in Group 1 and 11 patients in Group 2 remained in low disease activity state while receiving MTX monotherapy
The 1-year area under the curve (AUC) of DAS28 was lower in Group 2 owing to an initial better response
The total intake of anti-TNF- and the mean increase in total modified Sharp score was similar in the two groups

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