Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis
Objectives Methotrexate (MTX) is currently the recommended first-line therapy for treating psoriatic arthritis (PsA), despite lacking clear evidence. No estimates of efficacy of MTX in usual care and no clear MTX responsive clinical or laboratory variables are currently available. This study describ...
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BMJ Publishing Group
2020-09-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/6/2/e001175.full |
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| author | Ilja Tchetverikov J M W Hazes Hannah den Braanker Kim Wervers Adriana M C Mus Priyanka S Bangoer Nadine Davelaar Jolanda Luime Marijn Vis Erik Lubberts Marc R Kok |
| author_facet | Ilja Tchetverikov J M W Hazes Hannah den Braanker Kim Wervers Adriana M C Mus Priyanka S Bangoer Nadine Davelaar Jolanda Luime Marijn Vis Erik Lubberts Marc R Kok |
| author_sort | Ilja Tchetverikov |
| collection | DOAJ |
| description | Objectives Methotrexate (MTX) is currently the recommended first-line therapy for treating psoriatic arthritis (PsA), despite lacking clear evidence. No estimates of efficacy of MTX in usual care and no clear MTX responsive clinical or laboratory variables are currently available. This study describes the response to MTX monotherapy in newly diagnosed patients with PsA in usual care. Second, we compared clinical variables and cytokine profiles in patients responding and not responding to MTX monotherapy.Methods We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt study to select patients with PsA with oligoarthritis or polyarthritis, and at least 1 year follow-up. We analysed disease activity at 6 months of patients who started MTX monotherapy and still used MTX monotherapy 1 year after diagnosis. Cytokine profiles were determined at baseline and after 3 and 6 months with a bead-based multi-immunoassay.Results We identified 219 patients of which 183 (84%) patients started MTX monotherapy within 6 months after diagnosis. 90 patients used MTX monotherapy throughout the first year of which 44 patients (24%) reached minimal disease activity(MDA) at 6 months, decreasing to 33 patients (18%) after 1 year. Non-responders had significantly higher concentrations of interleukin (IL) 23 and IL-10 before and during MTX therapy.Conclusions Our results showed that only 18% of patients with PsA are in sustained MDA after 1 year of MTX monotherapy and non-responders more often had IL-23-driven disease. Our results indicate the need for more treat-to-target and personalised therapy strategies in PsA. |
| format | Article |
| id | doaj-art-24b4e5d985e5401e84ecc24f39c6a671 |
| institution | OA Journals |
| issn | 2056-5933 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-24b4e5d985e5401e84ecc24f39c6a6712025-08-20T01:54:26ZengBMJ Publishing GroupRMD Open2056-59332020-09-016210.1136/rmdopen-2020-001175Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritisIlja Tchetverikov0J M W Hazes1Hannah den Braanker2Kim Wervers3Adriana M C Mus4Priyanka S Bangoer5Nadine Davelaar6Jolanda Luime7Marijn Vis8Erik Lubberts9Marc R Kok10Rheumatology, Albert Sweitzer Hospital, Dordrecht, The NetherlandsDepartment of Rheumatology, Erasmus Medical Centre, Rotterdam, NetherlandsDepartment of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, NetherlandsErasmus MC, Rotterdam, NetherlandsDepartment of Rheumatology, Erasmus Medical Centre, Rotterdam, NetherlandsDepartment of Rheumatology, Erasmus Medical Centre, Rotterdam, NetherlandsDepartment of Rheumatology, Erasmus Medical Centre, Rotterdam, NetherlandsErasmus MC, Rotterdam, NetherlandsDepartment of Rheumatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Rheumatology, Erasmus Medical Center, Rotterdam, The NetherlandsRheumatology, Maasstad Ziekenhuis, Rotterdam, Zuid-Holland, NetherlandsObjectives Methotrexate (MTX) is currently the recommended first-line therapy for treating psoriatic arthritis (PsA), despite lacking clear evidence. No estimates of efficacy of MTX in usual care and no clear MTX responsive clinical or laboratory variables are currently available. This study describes the response to MTX monotherapy in newly diagnosed patients with PsA in usual care. Second, we compared clinical variables and cytokine profiles in patients responding and not responding to MTX monotherapy.Methods We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt study to select patients with PsA with oligoarthritis or polyarthritis, and at least 1 year follow-up. We analysed disease activity at 6 months of patients who started MTX monotherapy and still used MTX monotherapy 1 year after diagnosis. Cytokine profiles were determined at baseline and after 3 and 6 months with a bead-based multi-immunoassay.Results We identified 219 patients of which 183 (84%) patients started MTX monotherapy within 6 months after diagnosis. 90 patients used MTX monotherapy throughout the first year of which 44 patients (24%) reached minimal disease activity(MDA) at 6 months, decreasing to 33 patients (18%) after 1 year. Non-responders had significantly higher concentrations of interleukin (IL) 23 and IL-10 before and during MTX therapy.Conclusions Our results showed that only 18% of patients with PsA are in sustained MDA after 1 year of MTX monotherapy and non-responders more often had IL-23-driven disease. Our results indicate the need for more treat-to-target and personalised therapy strategies in PsA.https://rmdopen.bmj.com/content/6/2/e001175.full |
| spellingShingle | Ilja Tchetverikov J M W Hazes Hannah den Braanker Kim Wervers Adriana M C Mus Priyanka S Bangoer Nadine Davelaar Jolanda Luime Marijn Vis Erik Lubberts Marc R Kok Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis RMD Open |
| title | Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis |
| title_full | Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis |
| title_fullStr | Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis |
| title_full_unstemmed | Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis |
| title_short | Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis |
| title_sort | achieving sustained minimal disease activity with methotrexate in early interleukin 23 driven early psoriatic arthritis |
| url | https://rmdopen.bmj.com/content/6/2/e001175.full |
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