Recovery of clinical but not radiographic outcomes by the delayed addition of adalimumab to methotrexate-treated Japanese patients with early rheumatoid arthritis: 52-week results of the HOPEFUL-1 trial

Abstract

Objective: The aim of this study was to compare efficacy outcomes of initial treatment with adalimumab + MTX vs adalimumab addition following 26 weeks of MTX monotherapy in Japanese early RA patients naive to MTX with high disease activity.

Methods: Patients completing the 26-week, randomized, placebo-controlled trial of adalimumab + MTX were eligible to receive 26 weeks of open-label adalimumab + MTX. Patients were assessed for mean change from baseline in the 28-joint DAS with ESR (DAS28-ESR) and modified total Sharp score (mTSS), and for the proportions of patients achieving clinical, functional or radiographic remission.

Results: Of 333 patients assessed, 278 (137 from the initial adalimumab + MTX and 141 from the initial placebo + MTX groups) completed the 52-week study. Significant differences in clinical and functional parameters observed during the 26-week blinded period were not apparent following the addition of open-label adalimumab to MTX. Open-label adalimumab + MTX slowed radiographic progression through week 52 in both groups, but patients who received adalimumab + MTX throughout the study exhibited less radiographic progression than those who received placebo + MTX during the first 26 weeks (mean ΔmTSS at week 52 = 2.56 vs 3.30, P < 0.001).

Conclusion: Delayed addition of adalimumab in Japanese MTX-naive early RA patients did not impact clinical and functional outcomes at week 52 compared with the earlier addition of adalimumab. However, the accrual of significant structural damage during blinded placebo + MTX therapy contributed to the persistence of differences between the treatment strategies, suggesting that Japanese patients at risk for aggressive disease should benefit from the early inclusion of adalimumab + MTX combination therapy. Trial registration. ClinicalTrials.gov (http://clinicaltrials.gov/), NCT00870467.

Keywords: Japanese patients; MTX naive; adalimumab; rheumatoid arthritis; safety.

Fig. 1

Patient disposition through week 52. ^aPPS. One patient randomized to ADA + MTX received two doses of study drug at baseline and was excluded from this analysis. ^bThree patients in the ADA + MTX group and one in the PBO + MTX group discontinued from the study at week 26. ADA: adalimumab; PBO: placebo.

Fig. 2

Clinical and functional responses following up to 52 weeks of treatment with adalimumab (ADA) + MTX. (A) Mean DAS28-ESR values by visit. (B) The percentages of patients in remission (DAS28-ESR <2.6), low disease activity (DAS28-ESR ≥2.6 to ≤3.2), moderate disease activity (DAS28-ESR >3.2 to ≤5.1) or high disease activity (DAS28-ESR >5.1) at the indicated time points. (C) The percentages of patients satisfying the indicated definitions of clinical (SDAI, CDAI, Boolean) or functional (HAQ-DI) remission at weeks 26 and 52. ***P < 0.001, **P < 0.01 and *P < 0.05.

Fig. 3

Radiographic progression following up to 52 weeks of treatment with adalimumab (ADA) + MTX. (A) Box and whisker Tukey plot of change from baseline to week 26 or 52 in mTSS. Boxes represent interquartile range (25–75%); whiskers represent 1.5 times the interquartile range; line represents the median; dashed line represents the mean. (B) Cumulative distribution of change from baseline to week 52 in mTSS. (C) The percentages of patients in remission experiencing radiographic non-progression (ΔmTSS ≤0.5), radiographic progression (ΔmTSS >0.5 to ≤3.0) or clinically relevant radiographic progression (ΔmTSS >3.0) at the indicated time points. ***Statistical significance at the P < 0.001 level.