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Patients With More Severe Psoriatic Arthritis Benefit Most From Adalimumab Early On

By Maggie Schwarz

WASHINGTON, DC -- November 15, 2006 -- The anti-tumor necrosis factor agent adalimumab should be used early in the diagnosis of psoriatic arthritis in patients with 20 or more swollen joints, according to researchers who conducted the randomized, double-blind, placebo-controlled Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT) study.

Dafna Gladman, MD, FRCPC, professor of medicine, University of Toronto, Toronto, Ontario, Canada, presented the findings here at the American College of Rheumatology - Association of Rheumatology Health Professionals Annual Scientific Meeting (ACR-ARHP).

The 24-week ADEPT study evaluated the efficacy of adalimumab 40 mg versus placebo in 313 patients with moderate to severe psoriatic arthritis. In the original 2004 ADEPT trial, 54% of patients on adalimumab and 13% of those taking placebo had treatment responses.

In the present analysis, 296 patients with evaluable radiographs at baseline and at week 24 were divided into groups according to C-reactive protein (CRP), swollen joint counts and score on the health assessment questionnaire. Radiographic progression was the primary endpoint of the study.

Results show that adalimumab had radiographic efficacy at week 24 in all sufficiently large subgroups. Efficacy was observed whether or not patients used methotrexate at baseline or had an 20% response according to ACR criteria at week 24.

Patients with baseline CRP of 2 or greater had particularly severe radiographic progression, suggesting that CRP may be a marker for aggressive joint destruction in psoriatic arthritis, and that adalimumab inhibits radiographic progression and therefore provides benefit in such patients, according to Dr. Gladman.

"The drug inhibited damage, with a better response in sicker patients," she said. "Within 6 months there was suppression of radiographic disease. Women progressed more than men, and non-Caucasians more than Caucasians. Obese patients also did worse."

Dr. Gladman concluded that adalimumab should be used in mild or severe disease, though patients with more severe disease would benefit most from the drug early on.


[Presentation title: Adalimumab Radiographic Efficacy in Patients With Psoriatic Arthritis According to Demographics, Baseline Clinical Status, Methotrexate Use, and Clinical Response: Subanalysis of ADEPT. Abstract 3]

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