The Rate of Decrease in the Disease Activity of Rheumatoid Arthritis during Treatment with Adalimumab Depends on the Dose of Methotrexate

Koei Oh; Satoshi Ito; Megumi Unno; Daisuke Kobayashi; Chinatsu Azuma; Asami Abe; Hiroshi Otani; Hajime Ishikawa; Kiyoshi Nakazono; Ichiei Narita; Akira Murasawa

doi:10.2169/internalmedicine.54.4085

ORIGINAL ARTICLES

The Rate of Decrease in the Disease Activity of Rheumatoid Arthritis during Treatment with Adalimumab Depends on the Dose of Methotrexate

Koei Oh, Satoshi Ito, Megumi Unno, Daisuke Kobayashi, Chinatsu Azuma, Asami Abe, Hiroshi Otani, Hajime Ishikawa, Kiyoshi Nakazono, Ichiei Narita, Akira Murasawa

Author information

Koei Oh
Department of Rheumatology, Niigata Rheumatic Center, Japan
Department of Orthopaedic, Showa University Northern Yokohama Hospital, Japan
Satoshi Ito
Department of Rheumatology, Niigata Rheumatic Center, Japan
Megumi Unno
Department of Rheumatology, Niigata Rheumatic Center, Japan
Division of Clinical Nephrology and Rheumatology Niigata University Graduate School of Medical and Dental Sciences, Japan
Daisuke Kobayashi
Department of Rheumatology, Niigata Rheumatic Center, Japan
Division of Clinical Nephrology and Rheumatology Niigata University Graduate School of Medical and Dental Sciences, Japan
Chinatsu Azuma
Department of Rheumatology, Niigata Rheumatic Center, Japan
Department of Orthopedic Surgery, University of the Ryukyus, Japan
Asami Abe
Department of Rheumatology, Niigata Rheumatic Center, Japan
Hiroshi Otani
Department of Rheumatology, Niigata Rheumatic Center, Japan
Hajime Ishikawa
Department of Rheumatology, Niigata Rheumatic Center, Japan
Kiyoshi Nakazono
Department of Rheumatology, Niigata Rheumatic Center, Japan
Ichiei Narita
Division of Clinical Nephrology and Rheumatology Niigata University Graduate School of Medical and Dental Sciences, Japan
Akira Murasawa
Department of Rheumatology, Niigata Rheumatic Center, Japan

Keywords: adalimumab, concomitant therapy, methotrexate, rheumatoid arthritis, tumor necrosis factor

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 9 Pages 1035-1041

DOI https://doi.org/10.2169/internalmedicine.54.4085

Details

Abstract

Objective The aim of this study was to analyze the efficacy of adalimumab (ADA) in patients with rheumatoid arthritis treated with or without methotrexate (MTX) and determine impact of the MTX dose.
Methods Pearson's product-moment correlation coefficient was used to assess the correlations between the improvement in the Disease Activity Score (DAS) 28- erythrocyte sedimentation rate (ESR) score and the MTX dose in patients receiving treatment with MTX at a dose of <8 mg/week, 8 mg/week and >8 mg/week.
Patients ADA therapy was initiated in 68 rheumatoid arthritis patients between July 2008 and June 2013. The mean MTX dose was 9.6 ± 2.6 mg/week, and the patients were followed for 24 weeks.
Results The mean DAS28-ESR scores at baseline and week 24 were 4.6 ± 1.3 and 2.7 ± 1.2 in the 60 patients treated with MTX and 4.5 ± 1.0 and 4.2 ± 1.5 in the eight patients treated without MTX, respectively. Clinical remission was achieved in 48% and 25% of the patients, respectively, by week 24. Moreover, 90.0% of the patients taking MTX continued to receive ADA until week 24, while 50.0% of the patients not taking MTX continued to receive ADA until week 24. Among the 35 patients receiving MTX at a dose of >8 mg/week, the DAS28-ESR scores decreased rapidly from 4.4 ± 1.2 at baseline to 3.2 ± 1.1 at week 4 and further decreased to 2.4 ± 1.0 at week 24. Meanwhile, clinical remission was achieved in 57% of the patients receiving MTX at a dose of >8 mg/week and 36% of those receiving MTX at a dose of ≤8 mg/week. A significant correlation was noted between the improvement in the DAS-ESR score and the MTX dose.
Conclusion In this study population, enhanced clinical efficacy of ADA was achieved in combination with the administration of a sufficient dose of MTX, determined to be >8 mg/week.

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