Dr. Coates has received consulting fees, speaking fees, and/or honoraria (less than $10,000 each) from Centocor and Schering-Plough.
Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data
Version of Record online: 23 FEB 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 7, pages 965–969, July 2010
How to Cite
Coates, L. C. and Helliwell, P. S. (2010), Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data. Arthritis Care Res, 62: 965–969. doi: 10.1002/acr.20155
- Issue online: 29 JUN 2010
- Version of Record online: 23 FEB 2010
- Manuscript Accepted: 11 FEB 2010
- Manuscript Received: 14 DEC 2009
- Arthritis Research UK as an Arthritis Research UK Clinical Research Fellow
New criteria for minimal disease activity (MDA) in psoriatic arthritis (PsA) have been developed. The aim is to provide further validation of these criteria using data obtained in interventional trials with infliximab, a drug with proven efficacy in PsA.
The data were obtained from patients in phase II and III infliximab studies of PsA. In both studies, patients with active PsA were treated with infliximab (5 mg/kg) or placebo followed by a period of treatment with infliximab. Between-group comparisons in terms of those achieving MDA and the relationship of MDA to American College of Rheumatology outcomes, C-reactive protein levels, and radiologic progression were performed.
In the Infliximab Multinational Psoriatic Arthritis Controlled Trial, 48% (15 of 31) of infliximab-treated patients achieved MDA at week 16, compared with 3% (1 of 32) taking placebo (P < 0.0001). At week 50, 96% of those patients who achieved MDA showed no progression of radiologic disease (increase in the modified Sharp/van der Heijde score of ≤0), compared with 67% of those who did not achieve MDA (P = 0.012). In the Induction and Maintenance Psoriatic Arthritis Clinical Trial 2, 52% (40 of 77) of infliximab-treated patients achieved MDA at week 24, compared with 21% (17 of 80) receiving placebo (P < 0.001). At week 54, 78% of those patients who achieved MDA had no radiologic progression, compared with 57% of those who did not achieve MDA (P = 0.009).
Patients with active PsA achieving MDA with effective therapy have a significant reduction in radiographic progression. Aiming for low levels of disease activity can improve the outcome of patients with PsA even in a disease-modifying antirheumatic drug–resistant cohort. The new MDA criteria could provide an objective target for treatment in trials and clinical practice.