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戈利木单抗治疗银屑病关节炎:一项III期随机安慰剂对照试验的一年临床疗效、影像学及安全性结果

Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial.

作者信息

Kavanaugh Arthur, van der Heijde Désirée, McInnes Iain B, Mease Philip, Krueger Gerald G, Gladman Dafna D, Gómez-Reino Juan, Papp Kim, Baratelle Anna, Xu Weichun, Mudivarthy Surekha, Mack Michael, Rahman Mahboob U, Xu Zhenhua, Zrubek Julie, Beutler Anna

机构信息

Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, 9500 Gilman Drive, Room A-112, La Jolla, CA 92093-0943, USA.

出版信息

Arthritis Rheum. 2012 Aug;64(8):2504-17. doi: 10.1002/art.34436.

DOI:10.1002/art.34436
PMID:22378566
Abstract

OBJECTIVE

Golimumab, administered subcutaneously every 4 weeks, has been shown to be effective in reducing the signs and symptoms of active psoriatic arthritis (PsA) through week 24 of the GO-REVEAL study. Herein we report 1-year clinical, radiographic, and safety findings.

METHODS

Adult patients with active PsA (≥3 swollen and ≥3 tender joints) were randomly assigned to receive subcutaneous placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks through week 20. At week 16, patients with <10% improvement from baseline in swollen and tender joint counts entered a blinded early escape phase, with placebo crossover to golimumab 50 mg, golimumab 50 mg increased to 100 mg, and golimumab 100 mg continued at 100 mg. Patients receiving placebo who did not enter the early escape phase crossed over to golimumab 50 mg at week 24. Findings through 1 year are reported, including the second of 2 coprimary end points (i.e., change from baseline to week 24 in PsA-modified Sharp/van der Heijde score [SHS]).

RESULTS

A total of 405 patients were randomized: 113 to placebo and 146 each to the golimumab 50 mg and 100 mg groups. Mean changes in PsA-modified SHS from baseline to week 24 for the combined golimumab 50 mg and 100 mg group (-0.09) and the golimumab 50 mg group (-0.16) were significantly different versus placebo (0.27) (P = 0.015 and P = 0.011, respectively). Radiographic benefit was maintained through week 52 with golimumab. Clinical efficacy, including improvement in joint and skin responses and physical function, was maintained through 1 year. The frequency/types of adverse events were similar to those reported through week 24.

CONCLUSION

Treatment of PsA with golimumab inhibited structural damage progression and demonstrated continued clinical efficacy and safety through 1 year.

摘要

目的

在GO-REVEAL研究的第24周,已证明每4周皮下注射一次戈利木单抗可有效减轻活动性银屑病关节炎(PsA)的体征和症状。在此,我们报告1年的临床、影像学和安全性结果。

方法

活动性PsA(≥3个肿胀关节和≥3个压痛关节)的成年患者被随机分配,在第20周前每4周接受皮下注射安慰剂、50mg戈利木单抗或100mg戈利木单抗。在第16周时,肿胀和压痛关节计数较基线改善<10%的患者进入盲态早期退出阶段,安慰剂组交叉至50mg戈利木单抗组,50mg戈利木单抗组增至100mg,100mg戈利木单抗组维持100mg剂量。未进入早期退出阶段的接受安慰剂治疗的患者在第24周交叉至50mg戈利木单抗组。报告了1年的研究结果,包括2个共同主要终点中的第二个(即PsA改良Sharp/van der Heijde评分[SHS]从基线到第24周的变化)。

结果

共有405例患者被随机分组:113例接受安慰剂,146例分别接受50mg戈利木单抗组和100mg戈利木单抗组。50mg戈利木单抗组和100mg戈利木单抗联合组从基线到第24周PsA改良SHS的平均变化(-0.09)和50mg戈利木单抗组(-0.16)与安慰剂组(0.27)相比有显著差异(分别为P = 0.015和P = 0.011)。使用戈利木单抗至第52周时,影像学益处得以维持。临床疗效,包括关节和皮肤反应及身体功能的改善,在1年内得以维持。不良事件的频率/类型与第24周报告的相似。

结论

用戈利木单抗治疗PsA可抑制结构损伤进展,并在1年内持续显示出临床疗效和安全性。

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