title: Adalimumab response in patients with early versus established rheumatoid arthritis: DE019 randomized controlled trial subanalysis.
abstract: In recent years, there has been a shift in the therapeutic approach to rheumatoid arthritis (RA), with emphasis on early therapy. The DE019 trial demonstrated adalimumab efficacy in patients with RA. This subanalysis compares response to adalimumab based on clinical, functional, and radiographic outcomes in patients with early versus established RA. Patients enrolled in the DE019 trial were divided into two groups based on disease duration (<or=3 years=early RA; >3 years=established RA). Data from 407 patients with RA were included, with 78 early (41 adalimumab, 37 placebo) and 329 established (166 adalimumab, 163 placebo) patients. Patients with early disease achieved slightly greater American College of Rheumatology 20 (20% or more improvement or ACR20), 50, and 70 responses of 61%, 46.3%, and 24.4%, respectively, at 52 weeks, compared with those with established disease, with ACR20, 50, and 70 responses of 56%, 37.3%, and 19.9%, respectively. The Health Assessment Questionnaire score improvement between adalimumab and placebo in patients with early disease (0.44) was greater than that for those with established disease (0.25). With adalimumab treatment, there was a statistically significant mean reduction in total Sharp score progression relative to placebo (5.32) in early disease compared with established disease (2.06). While adalimumab is effective for RA of all disease durations, there is a trend toward superior clinical, functional, and radiographic outcomes in patients with early disease.
authors.affiliation: University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada. jamalsh@smh.toronto.on.ca
authors.forename: Shahin
authors.initials: S
authors.lastname: Jamal
authors.forename: Kaushik
authors.initials: K
authors.lastname: Patra
authors.forename: Edward C
authors.initials: EC
authors.lastname: Keystone
mesh_terms: D000068879:Adalimumab; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D018450:Disease Progression; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D010919:Placebos; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab