Laura C Coates1, Philip S Helliwell2. 1. From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK.L.C. Coates, NIHR Clinical Lecturer, MBChB, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust; P.S. Helliwell, Senior Lecturer, MA, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust. 2. From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK.L.C. Coates, NIHR Clinical Lecturer, MBChB, MRCP, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust; P.S. Helliwell, Senior Lecturer, MA, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust. p.helliwell@leeds.ac.uk.
Abstract
OBJECTIVE:Methotrexate (MTX) is a commonly used disease-modifying antirheumatic drug in psoriatic arthritis, but there is conflicting evidence to support its efficacy. METHODS: Within the Tight Control of Psoriatic Arthritis (TICOPA) study, patients were treated with MTX as part of the tight control protocol or standard care. Outcomes were recorded at the 12-week visit, including joint counts, skin, nail, enthesitis, dactylitis, and patient-reported measures. RESULTS: Of the 206 patients enrolled, 188 receivedMTX in the first 12 weeks of the trial with 104 receiving a mean dose > 15 mg/week. The proportions of patients achieving the American College of Rheumatology (ACR) outcomes at 12 weeks were ACR20 40.8%, ACR50 18.8%, and ACR70 8.6%, with 22.4% achieving minimal disease activity. Improvements were seen in psoriasis with 27.2% reaching a Psoriasis Area and Severity Index (PASI) 75. The proportion of patients with dactylitis and Leeds dactylitis instrument (LDI) scores decreased significantly (62.7% decrease in patients with dactylitis, median change LDI -59.7, -157.4 to -26.4, p = 0.033). The decrease in proportion of patients with enthesitis (25.7%) was significant, but the median change in enthesitis score was 0. There was a trend to higher proportions of patients receiving over 15 mg/week achieving ACR20, ACR50, and PASI75. CONCLUSION: Despite the open-label design of the data, improvements in multiple clinical outcomes were seen. The proportion of patients reaching ACR20 in the TICOPA study was higher than in the Methotrexate in Psoriatic Arthritis study (41% vs 34%), but no comparative data are available for other outcomes. There is a suggestion of a dose response, but this is hard to assess when patients doing well may be maintained on lower doses.
RCT Entities:
OBJECTIVE:Methotrexate (MTX) is a commonly used disease-modifying antirheumatic drug in psoriatic arthritis, but there is conflicting evidence to support its efficacy. METHODS: Within the Tight Control of Psoriatic Arthritis (TICOPA) study, patients were treated with MTX as part of the tight control protocol or standard care. Outcomes were recorded at the 12-week visit, including joint counts, skin, nail, enthesitis, dactylitis, and patient-reported measures. RESULTS: Of the 206 patients enrolled, 188 received MTX in the first 12 weeks of the trial with 104 receiving a mean dose > 15 mg/week. The proportions of patients achieving the American College of Rheumatology (ACR) outcomes at 12 weeks were ACR20 40.8%, ACR50 18.8%, and ACR70 8.6%, with 22.4% achieving minimal disease activity. Improvements were seen in psoriasis with 27.2% reaching a Psoriasis Area and Severity Index (PASI) 75. The proportion of patients with dactylitis and Leeds dactylitis instrument (LDI) scores decreased significantly (62.7% decrease in patients with dactylitis, median change LDI -59.7, -157.4 to -26.4, p = 0.033). The decrease in proportion of patients with enthesitis (25.7%) was significant, but the median change in enthesitis score was 0. There was a trend to higher proportions of patients receiving over 15 mg/week achieving ACR20, ACR50, and PASI75. CONCLUSION: Despite the open-label design of the data, improvements in multiple clinical outcomes were seen. The proportion of patients reaching ACR20 in the TICOPA study was higher than in the Methotrexate in Psoriatic Arthritis study (41% vs 34%), but no comparative data are available for other outcomes. There is a suggestion of a dose response, but this is hard to assess when patients doing well may be maintained on lower doses.
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Authors: Laura C Coates; Nuria Navarro-Coy; Sarah R Brown; Sarah Brown; Lucy McParland; Howard Collier; Emma Skinner; Jennifer Law; Anna Moverley; Sue Pavitt; Claire Hulme; Paul Emery; Philip G Conaghan; Philip S Helliwell Journal: BMC Musculoskelet Disord Date: 2013-03-21 Impact factor: 2.362
Authors: George Martin; Bruce E Strober; Craig L Leonardi; Joel M Gelfand; Andrew Blauvelt; Arthur Kavanaugh; Linda Stein Gold; Brian Berman; Ted Rosen; Eggert Stockfleth Journal: J Clin Aesthet Dermatol Date: 2016-09-01
Authors: Laure Gossec; Laura C Coates; Maarten de Wit; Arthur Kavanaugh; Sofia Ramiro; Philip J Mease; Christopher T Ritchlin; Désirée van der Heijde; Josef S Smolen Journal: Nat Rev Rheumatol Date: 2016-11-10 Impact factor: 20.543