Etanercept outperforms methotrexate for PsA

medwireNews: Etanercept has greater efficacy than methotrexate for the treatment of psoriatic arthritis (PsA), suggest phase III trial results presented at the 2018 ACR/ARHP Annual Meeting in Chicago, Illinois, USA.

"This is a trial that was necessary but never done," lead author Philip Mease (Swedish Medical Center and University of Washington, Seattle, USA) told medwireNews.

He explained that etanercept and methotrexate "are used a lot, and we just didn't have this data before to be able to support our use of these drugs."

As outlined in a late-breaking poster presentation, Mease and colleagues randomly assigned 851 methotrexate- and biologic-naïve patients with active PsA to receive once weekly treatment with etanercept 50 mg, methotrexate 20 mg, or a combination of both agents for a total of 48 weeks.

At the 24-week follow-up, ACR20 response rates were significantly higher among patients receiving etanercept alone or alongside methotrexate than with methotrexate alone, at 60.9% and 65.0% versus 50.7%, respectively. The corresponding rates at week 48 were 83.1% and 80.4% versus 70.7%.

Etanercept use was also associated with a significantly higher likelihood of achieving minimal disease activity (MDA; defined as tender and swollen joint counts ≤1; Psoriasis Area and Severity Index score ≤1 or psoriasis-affected body surface area ≤3%; visual analog scale [VAS] pain score ≤15; patient global disease activity VAS ≤20, HAQ-DI ≤0.5; and tender entheseal points ≤1). Specifically, the MDA rates at week 24 were 35.9% and 35.7% versus 22.9% for patients taking etanercept monotherapy and combination therapy versus methotrexate monotherapy, respectively.

Mease said that all three treatment arms experienced improvements in enthesitis and dactylitis scores over the study period, with numerically greater improvements for patients given etanercept or combination therapy versus methotrexate.

"So etanercept does better but not hugely better," and these results show that "methotrexate works" in terms of ACR and MDA responses, as well as enthesitis, dactylitis, and skin responses, said Mease.

However, "the one area where there was a question mark was in its ability to inhibit radiographic progression," he remarked. Mean changes in modified total Sharp Score from baseline to week 48 were –0.04 points for patients receiving etanercept monotherapy, –0.01 points for those given the combination of both drugs, and 0.08 points for patients given methotrexate alone.

Mease concluded that monotherapy with etanercept did as well as the combination of etanercept and methotrexate, which "tells me I'm doing fine if I drop methotrexate" from the combination.

By Claire Barnard

This information is brought to you by medwireNews and is not sponsored by, nor a part of, the American College of Rheumatology