Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: Two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial

Authors

  • Désirée van der Heijde,

    Corresponding author
    1. University Hospital, Maastricht, The Netherlands
    • Department of Rheumatology, University Hospital, Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Lars Klareskog,

    1. Karolinska Institute, Stockholm, Sweden
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Vicente Rodriguez-Valverde,

    1. Hospital Marques de Valdecilla, Universidad de Cantabria, Santander, Spain
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Catalin Codreanu,

    1. Central Methodologic de Reumatologie Bucuresti, Bucharest, Romania
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Horatiu Bolosiu,

    1. Clinica Reumatologica, Cluj-Napoca, Romania
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Jose Melo-Gomes,

    1. Instituto Portugues de Reumatologia, Lisbon, Portugal
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Jesus Tornero-Molina,

    1. Universitario de Guadalajara, Guadalajara, Spain
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Joseph Wajdula,

    1. Wyeth Research, Collegeville, Pennsylvania
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Ronald Pedersen,

    1. Wyeth Research, Collegeville, Pennsylvania
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • Saeed Fatenejad,

    1. Wyeth Research, Collegeville, Pennsylvania
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    • Drs. van der Heijde, Klareskog, Rodriguez-Valverde, Codreanu, Bolosiu, Melo-Gomes, and Tornero-Molina are paid participating investigators and/or consultants to Wyeth Research, compensated at less than $10,000 per year. Dr. van der Heijde has received consulting fees or honoraria (less than $10,000 per year) from Abbott, Centocor, Wyeth, Schering-Plough, and Bristol-Myers Squibb. Dr. Rodriguez-Valverde has received consulting fees or honoraria (less than $10,000 per year) from Wyeth and Bristol-Myers Squibb and has presented lectures for Wyeth, Schering-Plough, and Abbott. Dr. Tornero-Molina has received consulting fees or honoraria (less than $10,000 per year) and has provided expert testimony for Wyeth. Dr. Wajdula, Mr. Pedersen, and Dr. Fatenejad own stock in Wyeth.

  • TEMPO Study Investigators


Abstract

Objective

To evaluate the efficacy, including radiographic changes, and safety of etanercept and methotrexate (MTX), used in combination and alone, in patients with rheumatoid arthritis (RA) in whom previous treatment with a disease-modifying antirheumatic drug other than MTX had failed.

Methods

Patients with RA were treated with etanercept (25 mg subcutaneously twice weekly), oral MTX (up to 20 mg weekly), or combination therapy with etanercept plus MTX through a second year, in a double-blinded manner. Clinical response was assessed using American College of Rheumatology (ACR) criteria and the Disease Activity Score (DAS), in a modified intent-to-treat analysis with the last observation carried forward (LOCF) and in a population of completers. Radiographs of the hands, wrists, and forefeet were scored for erosions and joint space narrowing at annual intervals.

Results

A total of 503 of 686 patients continued into year 2 of the study. During the 2 years, significantly fewer patients receiving combination therapy withdrew from the study (29% of the combination therapy group, 39% of the etanercept group, and 48% of the MTX group). Both the LOCF and the completer analyses yielded similar results. The ACR 20% improvement (ACR20), ACR50, and ACR70 responses and the remission rates (based on a DAS of <1.6) were significantly higher with combination therapy than with either monotherapy (P < 0.01). Similarly, improvement in disability (based on the Health Assessment Questionnaire) was greater with combination therapy (P < 0.01). The combination therapy group showed significantly less radiographic progression than did either group receiving monotherapy (P < 0.05); moreover, radiographic progression was significantly lower in the etanercept group compared with the MTX group (P < 0.05). For the second consecutive year, overall disease progression in the combination therapy group was negative, with the 95% confidence interval less than zero. Adverse events were similar in the 3 treatment groups.

Conclusion

Etanercept in combination with MTX reduced disease activity, slowed radiographic progression, and improved function more effectively than did either monotherapy over a 2-year period. No increase in toxicity was associated with combination treatment with etanercept plus MTX.

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