Disease remission and sustained halting of radiographic progression with combination etanercept and methotrexate in patients with rheumatoid arthritis

• Published in: Arthritis and rheumatism 2007-12, Vol.56 (12), p.3928-3939
• Main Authors: van der Heijde, D., Klareskog, L., Landewé, R., Bruyn, G. A. W., Cantagrel, A., Durez, P., Herrero‐Beaumont, G., Molad, Y., Codreanu, C., Valentini, G., Zahora, R., Pedersen, R., MacPeek, D., Wajdula, J., Fatenejad, S.
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - physiopathology; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Disability Evaluation; Diseases of the osteoarticular system; Double-Blind Method; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin G - adverse effects; Immunoglobulin G - therapeutic use; Immunomodulators; Inflammatory joint diseases; Longitudinal Studies; Male; Medical sciences; Medicin och hälsovetenskap; Methotrexate - adverse effects; Methotrexate - therapeutic use; Multivariate Analysis; Pharmacology. Drug treatments; Radiography; Receptors, Tumor Necrosis Factor - therapeutic use; Remission Induction; Severity of Illness Index; Treatment Outcome
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.23141

Objective The Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) is a 3‐year, double‐blind, multicenter study evaluating the efficacy and safety of etanercept, methotrexate, and the combination of etanercept plus methotrexate in patients with active rheumatoid arthritis (RA). The results after 1 and 2 years of the study have been previously reported. Here we provide the 3‐year clinical and radiographic outcomes and safety of etanercept, methotrexate, and the combination in patients with RA. Methods In this randomized, double‐blind, multicenter TEMPO study, 682 patients received etanercept 25 mg twice weekly, methotrexate ≤20 mg weekly, or the combination. Key efficacy assessments included the Disease Activity Score (DAS) and the DAS in 28 joints. Results Combination therapy resulted in significantly greater improvement in the DAS and in more patients with disease in remission than either monotherapy. This finding was confirmed by longitudinal analysis; patients receiving combination therapy were more than twice as likely to have disease in remission than those receiving either monotherapy. Independent predictors of remission included male sex, lower disease activity, lower level of joint destruction, and/or better physical function. Combination and etanercept therapy both resulted in significantly less radiographic progression than did methotrexate (P < 0.05). Etanercept and combination treatment were well tolerated, with no new safety findings. Conclusion Etanercept plus methotrexate showed sustained efficacy through 3 years and remained more effective than either monotherapy, even after adjustment for patient withdrawal. Combination therapy for 3 years led to disease remission and inhibition of radiographic progression, 2 key goals for treatment of patients with RA.