February 20, 2018
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Younger age, lower BMI linked to remission in RA

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Younger age, lower BMI and lower Health Assessment Questionnaire scores were associated with 36-week remission in patients with rheumatoid arthritis treated with a combination of etanercept and methotrexate, according to findings published in Arthritis Research and Therapy.

“Clinical remission is a critical treatment target in all patients with [RA], regardless of the level of their disease activity,” Josef S. Smolen, MD, of the Medical University of Vienna, and colleagues wrote. “Although treatment with biologics such as TNF inhibitors is effective in inducing and maintaining remission in patients with RA, the determining factors associated with remission induction with biologic therapy, and remission maintenance after such therapy is reduced or discontinued, have not yet been well-studied.”

To determine the predictors for remission induction and loss of remission, in patients with moderately active RA who received modified etanercept (Enbrel, Amgen) dosing, the researchers conducted a post hoc analysis of the PRESERVE trial. That study assessed the consequences of etanercept dose reduction or withdrawal in adults with moderately active RA who achieved low disease activity after 36 weeks of treatment with full-dose etanercept combined with methotrexate. In the study, all 834 patients enrolled in the initial open-label period received 50 mg of etanercept once weekly plus methotrexate for 36 weeks.

Patients who achieved a low DAS28 by 36 weeks were randomly selected to receive double-blind treatment with either 50 mg or 25 mg of etanercept, or placebo, once per week plus methotrexate for 52 weeks. The PRESERVE trial found that full-dose or reduced-dose etanercept-methotrexate combination therapy was more effective in maintaining low disease activity than methotrexate alone after etanercept withdrawal.

According to the researchers, their post hoc analysis found that younger age, a BMI of less than 30 kg/m2 and a lower Health Assessment Questionnaire score at baseline were significant predictors of remission at week 36 (P < .05). Meanwhile, DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) scores at baseline were significant predictors of remission at all three endpoints (P < .05).

In addition, among all treatments, the strongest predictors of remission loss were failure to achieve sustained remission with initial therapy, higher DAS28, SDAI and CDAI at randomization and 1 month, increases in DAS28, SDAI and CDAI at 1 month and increases in DAS28, SDAI and CDAI components and outcomes after the first month.

“The findings of the analyses in the current report suggest that targeting sustained and stringently defined clinical remission in patients receiving full-dose combination etanercept-plus-methotrexate therapy before considering dose or regimen changes may help improve the likelihood that patients will remain in clinical remission 1 year after the changes are made,” Smolen and colleagues wrote.

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The researchers added that, “Patients who are younger and have BMI <30 kg/m2, lower HAQ scores, and lower disease activity, as measured by DAS28, SDAI, and CDAI, at baseline may be most likely to achieve a remission state with full-dose combination etanercept-methotrexate induction therapy, whereas those who achieve an early, strong and durable response to induction therapy are most likely to experience a sustained response after biologic tapering or withdrawal.” – by Jason Laday

Disclosure: The researchers report funding from Wyeth and Pfizer. Smolen reports receiving research grants and consulting fees from AbbVie, BMS, MSD, Pfizer, and Roche, and consulting fees from Astra-Zeneca, Boehringer Ingelheim, Celgene, Celtrion, GSK, ILTOO, Janssen, Lilly, Novartis-Sandoz, Samsung, and UCB.