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Effectiveness of adalimumab in treating patients with active psoriatic arthritis and predictors of good clinical responses for arthritis, skin and nail lesions Van den Bosch F; Manger B; Goupille P; McHugh N; Rodevand E; Holck P; van Vollenhoven RF; Leirisalo-Repo M; Fitzgerald O; Kron M; Frank M; Kary S; Kupper HAnn Rheum Dis 2010[Feb]; 69 (2): 394-9OBJECTIVES: To evaluate the effectiveness of adalimumab in patients with psoriatic arthritis (PsA) and identify predictors of good clinical response for joint and skin lesions. METHODS: Patients received adalimumab 40 mg every other week in addition to standard therapy in this prospective, 12-week, open-label, uncontrolled study. Four definitions of good clinical response were used: > or =50% improvement in American College of Rheumatology response criteria (ACR50), good response according to European League Against Rheumatism (EULAR) guidelines, a > or =3-grade improvement in Physician Global Assessment of psoriasis (PGA) and a > or =50% improvement in the Nail Psoriasis Severity Index (NAPSI). Response predictors were determined by logistic regression with backward elimination (selection level was 5%). RESULTS: Of 442 patients, 94% completed 12 weeks of treatment. At week 12, 74%, 51% and 32% of the patients had achieved ACR20, 50 and 70, respectively; 87% and 61% experienced moderate and good responses according to EULAR criteria, respectively. The percentage of patients with PGA results of "clear/almost clear" increased from 34% (baseline) to 68%. The mean NAPSI score was reduced by 44%. No new safety signals were detected. A lower Health Assessment Questionnaire Disability Index (HAQ-DI) score, greater pain assessment, male sex and absence of systemic glucocorticoid therapy were strongly associated with achievement of ACR50 and good response according to EULAR criteria. In addition, greater C-reactive protein concentration and polyarthritis predicted ACR50, and non-involvement of large joints predicted a good response according to EULAR criteria. CONCLUSIONS: Adalimumab was effective in patients with PsA. Lower impairment of physical function, greater pain, male sex and no systemic treatment with glucocorticoids were factors that increased the chance of achieving a good clinical response.|Adalimumab[MESH]|Adult[MESH]|Antibodies, Monoclonal, Humanized[MESH]|Antibodies, Monoclonal/*therapeutic use[MESH]|Antirheumatic Agents/*therapeutic use[MESH]|Arthritis, Psoriatic/*drug therapy[MESH]|Dermatologic Agents/*therapeutic use[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Nail Diseases/drug therapy[MESH]|Prognosis[MESH]|Prospective Studies[MESH]|Psoriasis/drug therapy[MESH]|Severity of Illness Index[MESH]|Treatment Outcome[MESH] |
