According to a recent study in Arthritis Care and Research, the majority of patients taking tumor necrosis factor-alpha (TNF-alpha) blockers, such as Humira (adalimumab), Enbrel (etanercept), Remicade (infliximab) and Simponi (golimumab), achieved a level of improvement known as Minimal Disease Activity (MDA). MDA occurs when patients see dramatic relief from most of their psoriatic arthritis symptoms, and is considered by many doctors to be the goal of treatment.
In addition to studying the characteristics of patients who achieved MDA, researchers also examined whether patients who stopped treatment could sustain this level of improvement.
The study enrolled 226 people with psoriatic arthritis, approximately two-thirds of whom were men. Researchers checked in with patients every six to12 months to perform a physical examination and conduct blood tests, looking for symptoms such as joint damage and skin disease. To be considered in a state of MDA, patients had to meet criteria such as having no more than one swollen joint, and little or no skin psoriasis.
Almost two-thirds of patients achieved MDA within an average of about 15 months, the researchers reported. Among these, 88 were able to sustain MDA for at least a year, for an average duration of almost three-and-a-half years, according to the study.
Of the patients who achieved MDA, nine reduced their therapy dose and eight stopped taking the drug altogether. These patients stayed in MDA state for an average of about two years, although, the researchers noted, people who only reduced their therapy sustained MDA for longer than people who stopped.
Researchers also found that men were more likely than women to achieve MDA, as were people with lower levels of inflammation. Researchers measured inflammation by testing patients’ erythrocyte sedimentation rate (ESR). According to the Mayo Clinic, ESR is a measurement of how quickly red blood cells clump together, which can be a sign of inflammation. A normal ESR, indicating less inflammation, more than doubled the odds of achieving MDA, the researchers reported.
Although many patients in the study did see dramatic improvement, more than a third did not achieve MDA, the researchers noted. More studies are needed to better understand how to manage treatment with TNF-alpha blockers, and how to treat patients who do not respond to these drugs, the researchers conclude.
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