title: Certolizumab pegol plus MTX administered every 4 weeks is effective in patients with RA who are partial responders to MTX.
abstract: OBJECTIVE
  Certolizumab pegol (CZP) is known to be effective as monotherapy at a dosage of 400  mg every 4 weeks in patients with active RA who have failed DMARDs. The aim of this study was to investigate every 4-week CZP in addition to continued MTX therapy in patients with an inadequate response to MTX alone.
  
  
  METHODS
  Patients with active RA with inadequate response to MTX, on background MTX, were randomized to double-blind treatment with CZP 400  mg or placebo every 4 weeks for 24 weeks (NCT00544154). The primary efficacy end-point was the ACR 20% improvement criteria (ACR20) response rate at Week 24. Other end-points included ACR50 and ACR70 response rates, ACR core components, 28-joint DAS (ESR) with three variables (DAS28-3) and health-related quality-of-life outcomes in addition to safety.
  
  
  RESULTS
  Of 247 randomized patients, 126 received CZP and 121 received placebo, in addition to MTX. ACR20 response rates were 45.9 vs 22.9%, respectively [P < 0.001 analysed by the Cochran-Mantel-Haenszel (CMH) method], with improvements being apparent from Week 1. Statistically significant improvements over placebo were seen with CZP for ACR50, ACR core components, DAS28-3 and physical functioning. Rates of treatment-related adverse events were similar between groups (25.0 vs 27.7%), and there were no deaths or serious opportunistic infections.
  
  
  CONCLUSIONS
  CZP 400  mg every 4 weeks plus MTX demonstrated a favourable risk-benefit profile with rapid onset of action in RA patients with an inadequate response to an earlier MTX therapy.
authors.affiliation: Department of Medicine, Section of Rheumatology, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK. choyeh@cardiff.ac.uk
authors.forename: Ernest
authors.initials: E
authors.lastname: Choy
authors.forename: Frank
authors.initials: F
authors.lastname: McKenna
authors.forename: Jiri
authors.initials: J
authors.lastname: Vencovsky
authors.forename: Robert
authors.initials: R
authors.lastname: Valente
authors.forename: Niti
authors.initials: N
authors.lastname: Goel
authors.forename: Brenda
authors.initials: B
authors.lastname: Vanlunen
authors.forename: Owen
authors.initials: O
authors.lastname: Davies
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Stahl
authors.forename: Rieke
authors.initials: R
authors.lastname: Alten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D000068582:Certolizumab Pegol; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007140:Immunoglobulin Fab Fragments; D007155:Immunologic Factors; D011092:Polyethylene Glycols; D000068582:Certolizumab Pegol; D008727:Methotrexate