Disconnect between inflammation and joint destruction after treatment with etanercept plus methotrexate: Results from the trial of etanercept and methotrexate with radiographic and patient outcomes

Authors

  • Robert Landewé,

    Corresponding author
    1. University Hospital Maastricht, Maastricht, The Netherlands
    • Department of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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    • Dr. Landewé has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, UCB, and Wyeth. Dr. van der Heijde has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, and Wyeth. Dr. Klareskog has received consultancies (less than $10,000) from Abbott, Amgen, Bristol-Myers Squibb, Roche, Schering-Plough, and Wyeth. Dr. van Vollenhoven has received consultancies and/or honoraria (less than $10,000) from Abbott, Centocor, Roche, Schering-Plough, and Wyeth. Dr. Fatenejad owns stock or stock options (more than $10,000) in Wyeth.

  • Désirée van der Heijde,

    1. University Hospital Maastricht, Maastricht, The Netherlands
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    • Dr. Landewé has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, UCB, and Wyeth. Dr. van der Heijde has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, and Wyeth. Dr. Klareskog has received consultancies (less than $10,000) from Abbott, Amgen, Bristol-Myers Squibb, Roche, Schering-Plough, and Wyeth. Dr. van Vollenhoven has received consultancies and/or honoraria (less than $10,000) from Abbott, Centocor, Roche, Schering-Plough, and Wyeth. Dr. Fatenejad owns stock or stock options (more than $10,000) in Wyeth.

  • Lars Klareskog,

    1. Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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    • Dr. Landewé has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, UCB, and Wyeth. Dr. van der Heijde has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, and Wyeth. Dr. Klareskog has received consultancies (less than $10,000) from Abbott, Amgen, Bristol-Myers Squibb, Roche, Schering-Plough, and Wyeth. Dr. van Vollenhoven has received consultancies and/or honoraria (less than $10,000) from Abbott, Centocor, Roche, Schering-Plough, and Wyeth. Dr. Fatenejad owns stock or stock options (more than $10,000) in Wyeth.

  • Ronald van Vollenhoven,

    1. Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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    • Dr. Landewé has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, UCB, and Wyeth. Dr. van der Heijde has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, and Wyeth. Dr. Klareskog has received consultancies (less than $10,000) from Abbott, Amgen, Bristol-Myers Squibb, Roche, Schering-Plough, and Wyeth. Dr. van Vollenhoven has received consultancies and/or honoraria (less than $10,000) from Abbott, Centocor, Roche, Schering-Plough, and Wyeth. Dr. Fatenejad owns stock or stock options (more than $10,000) in Wyeth.

  • Saeed Fatenejad

    1. Wyeth Research, Collegeville, Pennsylvania
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    • Dr. Landewé has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, UCB, and Wyeth. Dr. van der Heijde has received consultancies and/or honoraria (less than $10,000) from Abbott, Amgen, Centocor, Schering-Plough, and Wyeth. Dr. Klareskog has received consultancies (less than $10,000) from Abbott, Amgen, Bristol-Myers Squibb, Roche, Schering-Plough, and Wyeth. Dr. van Vollenhoven has received consultancies and/or honoraria (less than $10,000) from Abbott, Centocor, Roche, Schering-Plough, and Wyeth. Dr. Fatenejad owns stock or stock options (more than $10,000) in Wyeth.


Abstract

Objective

To determine the relationship between disease activity and radiographic progression of joint destruction in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX), those treated with etanercept, and those treated with the combination of MTX plus etanercept.

Methods

Baseline, 12-month, and 24-month data from the Trial of Etanercept and Methotrexate with Radiographic and Patient Outcomes database were analyzed. The dependent variable was the 1-year change in the modified Sharp/van der Heijde score (Sharp score); therefore, 2 interval changes per patient were available. Interval change in the Sharp score was modeled by time (years), treatment, disease activity, and the interaction (disease activity × treatment). Disease activity was reflected by the time-averaged Disease Activity Score (taDAS) and the time-averaged C-reactive protein (taCRP) level, which were calculated per 1-year interval. Generalized mixed linear modeling (GMLM) was used to adjust for within-patient correlation.

Results

GMLM confirmed a significant interaction between treatment and the taCRP level and taDAS with respect to the change in Sharp score (P = 0.012 and P = 0.03, respectively). In patients treated with MTX alone, radiographic progression increased with an increasing taCRP level or taDAS, although progression rates were low in patients whose disease was in remission and in those with low-to-moderate disease activity. This relationship was less clear in patients treated with etanercept and was absent in those who received combination therapy.

Conclusion

Combination therapy with MTX plus etanercept uncouples the classic relationship between disease activity and radiographic progression in patients with RA.

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