Journal
ARTHRITIS RESEARCH & THERAPY
Volume 12, Issue 3, Pages -Publisher
BIOMED CENTRAL LTD
DOI: 10.1186/ar3049
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Funding
- Abbott Laboratories
- Amgen
- Bristol-Myers Squibb
- Centocor
- Roche
- UCB
- Schering
- Wyeth
- BiogenIdec
- Bristol Myers Squibb
- Genentech
- Pfizer
- Schering-Plough
- Eli Lilly
- Jazz Pharmaceuticals
- Boehringer Ingelheim
- Pierre Fabre Medicament
- Chelsea Therapeutics
- Biogen
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Introduction: To identify independent predictors of radiographic progression in psoriatic arthritis (PsA) for patients treated with adalimumab or placebo in the Adalimumab Effectiveness in PsA Trial (ADEPT). Methods: Univariate analyses and multivariate linear regression analyses assessed risk for radiographic progression (change in modified total Sharp score, Delta mTSS > 0.5) from baseline to week 24 for C-reactive protein (CRP) and other baseline variables, and for 24-week time-averaged CRP (univariate analysis only). Subanalyses determined mean Delta mTSS for CRP subgroups. Analyses were post hoc, with observed data. Results: One hundred and forty-four adalimumab-treated patients and 152 placebo-treated patients were assessed. Mean CRP was 64% lower by week 2 with adalimumab and essentially unchanged with placebo. Univariate analyses indicated that elevated CRP at baseline and time-averaged CRP were strongly associated with radiographic progression for placebo-treated patients but not for adalimumab-treated patients. Multivariate analysis confirmed that elevated baseline CRP was the only strong independent risk factor for radiographic progression (for CRP >= 1.0 mg/dl: odds ratio = 3.28, 95% confidence interval = 1.66 to 6.51, P < 0.001). Adalimumab treatment reduced risk of progression approximately fivefold. The difference between mean Delta mTSS for adalimumab versus placebo was greatest for patients with baseline CRP >= 2.0 mg/dl (-0.5 vs. 2.6). Conclusions: Systemic inflammation in PsA, as indicated by elevated baseline CRP, was the only strong independent predictor of radiographic progression. This association was observed predominantly for placebo-treated patients. Adalimumab treatment substantially reduced the overall risk of radiographic progression, and provided greatest radiographic benefit for patients with the greatest CRP concentrations at baseline.
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