title: Application and modifications of minimal disease activity measures for patients with psoriatic arthritis treated with adalimumab: subanalyses of ADEPT.
abstract: OBJECTIVE
  This posthoc analysis evaluated the percentage of patients with psoriatic arthritis (PsA) who achieved minimal disease activity (MDA) and compared the results with a modified MDA substituting the physician global assessment (PGA) for the Psoriasis Activity and Severity Index (PASI) using data from the ADalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT; NCT00646386).
  
  
  METHODS
  Patients with active PsA were randomized to receive adalimumab 40 mg or placebo every other week for 24 weeks. MDA was defined as achieving ≥ 5 of the following criteria: tender joint count ≤ 1; swollen joint count ≤ 1; PASI ≤ 1 or body surface area ≤ 3%; patient pain score ≤ 15 [1-100 mm visual analog scale (VAS)]; patient global assessment (PGA) of disease activity ≤ 20 (1-100 mm VAS); Health Assessment Questionnaire ≤ 0.5; and tender entheseal points ≤ 1 (only heels assessed). For modification of the MDA, PASI ≤ 1 was substituted with PGA "Clear" as MDAPGA1 and PGA "Clear" or "Almost clear" as MDAPGA2.
  
  
  RESULTS
  Sixty-seven patients were treated with adalimumab and 69 with placebo. At Week 24, MDA, MDAPGA1, and MDAPGA2 were achieved by 39%, 37%, and 39%, respectively, of patients treated with adalimumab versus 7%, 5%, and 8% of patients on placebo (p < 0.001). Kappa coefficients indicated good agreement between PASI and PGA at Week 24.
  
  
  CONCLUSIONS
  ADEPT results indicated that significantly more patients treated with adalimumab achieved MDA by Week 24 compared with placebo. Modification of the MDA by replacing PASI ≤ 1 with PGA assessments did not alter the results, which may improve feasibility of practical use of the index.
authors.affiliation: Swedish Medical Center and University of Washington, Seattle, Washington 98122, USA. pmease@philipmease.com
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Mease
authors.forename: Michele
authors.initials: M
authors.lastname: Heckaman
authors.forename: Sonja
authors.initials: S
authors.lastname: Kary
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kupper
mesh_terms: D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab
keywords: ADALIMUMAB; PSORIATIC ARTHRITIS; SEVERITY OF ILLNESS INDEX