RESEARCH - Adding Enbrel to MTX may improve outcomes in RA: COMET

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Adding Etanercept to Methotrexate May Improve Outcomes in Rheumatoid Arthritis

March 26, 2009 — Adding etanercept to methotrexate may improve

patient-reported outcomes (PROs) and remission in active early

rheumatoid arthritis (RA), according to the results of a double-blind,

randomized clinical trial reported in the March 16 Online First issue

of the ls of the Rheumatic Diseases.

" The COMET (Combination of methotrexate [MTX] and etanercept [ETN] in

active early rheumatoid arthritis) trial, which enrolled

moderate-to-severe RA patients with disease duration from three months

to two years inclusive, found that early intervention with ETN+MTX

combination therapy prevented further joint damage with half the

patients reaching clinical remission at the end of the study's first

year, " write J. Kekow, from University of Magdeburg, in Magdeburg,

Germany, and colleagues from The COMET trial. " Objectives of the

present study were to examine the effects of combination therapy with

ETN+MTX versus MTX alone on HRQoL [health-related quality of life],

using PROs in COMET trial patients and to assess the relationship

between remission and PRO improvement. "

In COMET, patients were randomly assigned to receive etanercept, 50 mg

once weekly plus methotrexate, or methotrexate alone. PROs included

the Health Assessment Questionnaire (HAQ), EuroQoL health status,

fatigue and pain visual analog scales, Hospital Anxiety and Depression

Scale, and Medical Outcomes Short Form-36 (SF-36). This study includes

results from week 52, with mean changes from baseline analyzed by

analysis of covariance with use of last observation carried forward.

Compared with methotrexate alone, the etanercept plus methotrexate

group had significantly greater improvements in most PROs, including

physical functioning, pain, fatigue, and overall health status.

Improvement in HAQ score was significantly greater in the etanercept

plus methotrexate group vs the methotrexate-alone group (–1.02 vs

–0.72; P < .001), as was the proportion reaching the minimal

clinically important difference of 0.22 (88% vs 78%; P < .006). The

association between PRO score and clinical status showed that patients

achieving remission had the greatest improvement.

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Read the full article here:

http://www.medscape.com/viewarticle/590210

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