Patients with psoriatic arthritis and psoriasis report having a better response to etanercept the earlier they are treated, according to a post hoc analysis of the PRESTA trial.
Patients with shorter psoriatic arthritis (PsA) duration had greater improvements in arthritis scores and several patient-reported outcomes at 24 weeks of treatment with etanercept 50 mg a week, compared with patients with longer disease duration.
Courtesy Wikimedia Commons/James Heilman/Creative Commons License
Etanercept treatment should start early in patients with psoriatic arthritis, the study suggests.
The researchers, led by Dr. Bruce Kirkham from Guy’s and St. Thomas’ NHS Foundation Trust, London, said the results showed “clinicians should consider treating their PsA patients with therapies effective in PsA early rather than late.”
The industry-sponsored PRESTA (Psoriasis Randomized Etanercept Study in Patients with Psoriatic Arthritis) trial was a randomized, blinded, 24-week, multicenter study enrolling adults with active but stable plaque psoriasis involving at least 10% body surface area and active PsA defined as 2 or more swollen joints, 2 or more tender joints, joint pain for 3 months or longer, and a negative serum rheumatoid factor within 6 months prior to baseline.
Overall, 372 patients who received etanercept 50 mg once a week for 24 weeks were included in the current post hoc analysis (Clin. Exp. Rheumatol. 2014 Dec. 22).
Baseline and after treatment changes were compared between patients with PsA disease duration of 2 years or less (n = 103) and those with disease more than 2 years (n = 269).
Baseline efficacy measures were similar between the shorter duration and longer duration groups, with the exception of Physicians Global Assessment (PGA) arthritis score, which was significantly lower in the group with 2 years or less duration (44.9 vs. 51.8; P = .006), the authors reported.
At week 24, joint disease improved, based on the PGA arthritis score, by a significantly greater amount in the shorter duration group (–39.8 vs. –35.7; P = .03).
Clinically meaningful improvements in patient-reported outcomes with etanercept treatment occurred in both groups, the study authors said, but changes in scores from baseline to week 24 were significantly higher in the shorter duration group for visual analog scale reports of joint pain (P = .007) and arthritis activity (P = .01) as well as quality of life on EuroQol 5D utility (P = .046) and EuroQol 5D visual analog scale (P = .04) responses.
The mean number of swollen joints that had improved from baseline to week 24 was not significantly different between the groups, and no significant between-group differences were seen in the percentages of patients achieving the ACR20, ACR50, and ACR70 responses.
While all patients responded to treatment irrespective of disease duration, patients with shorter disease duration had greater improvements on some measures, the authors concluded.
However, the study was limited by the fact that it was a post hoc analysis and the original trial was not designed to explore the effect of early treatment versus later treatment in patients with PsA and moderate-to-severe psoriasis, they noted.
The study was sponsored by Wyeth, which was acquired by Pfizer, the manufacturer of etanercept, in October 2009. Several of the authors declared receiving honoraria from several pharmaceutical companies. Two authors were employees of Pfizer during the PRESTA study and development of the current manuscript, and two other authors are current employees of Pfizer.