Fleischmann Roy, Weinblatt Michael E, Schiff Michael, Khanna Dinesh, Maldonado Michael A, Nadkarni Anagha, Furst Daniel E
University of Texas Southwestern Medical Center, Dallas.
Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2016 Jul;68(7):907-13. doi: 10.1002/acr.22763.
To report 2-year patient-reported outcomes (PROs) from the head-to-head Abatacept versus Adalimumab Comparison in Biologic-Naive RA Subjects with Background Methotrexate (MTX) (AMPLE) trial.
AMPLE was a phase IIIb, randomized, investigator-blinded trial. Biologic-naive patients with rheumatoid arthritis (RA) and an inadequate response to MTX were randomized to subcutaneous (SC) abatacept (125 mg/week) or adalimumab (40 mg every 2 weeks) with background MTX. PROs (pain, fatigue, ability to perform work, and ability to perform daily activities) were compared up to year 2 for patients in each treatment group, as well as those who achieved low disease activity at both years 1 and 2 (responders) and those who did not (nonresponders).
A total of 646 patients were randomized and treated with SC abatacept (n = 318) or adalimumab (n = 328). Baseline characteristics were balanced between the 2 treatment arms. Comparable improvements in PROs were observed in the abatacept and adalimumab groups over 2 years, with both groups achieving clinically meaningful improvements in PROs from baseline. At year 2, fatigue improved by 23.4 mm and 21.5 mm on a 100-mm visual analog scale with abatacept and adalimumab, respectively. Clinical responders achieved greater improvements in PROs than nonresponders.
In biologic-naive patients with active RA, despite prior MTX, treatment with SC abatacept or adalimumab with background MTX resulted in comparable improvements in PROs, which were highly correlated with physician-reported clinical response end points.
报告在初治类风湿关节炎(RA)患者中使用甲氨蝶呤(MTX)作为背景治疗时,阿巴西普与阿达木单抗头对头比较的两年患者报告结局(PROs)(AMPLE)试验结果。
AMPLE是一项IIIb期、随机、研究者设盲试验。对MTX反应不足的初治类风湿关节炎(RA)患者被随机分为皮下注射(SC)阿巴西普(125mg/周)或阿达木单抗(每2周40mg),并联合MTX作为背景治疗。比较各治疗组患者至第2年的PROs(疼痛、疲劳、工作能力和日常活动能力),以及在第1年和第2年均达到低疾病活动度的患者(反应者)和未达到的患者(无反应者)。
共有646例患者被随机分组,分别接受SC阿巴西普(n = 318)或阿达木单抗(n = 328)治疗。两个治疗组的基线特征均衡。在2年期间,阿巴西普组和阿达木单抗组的PROs均有可比的改善,两组的PROs均从基线水平取得了具有临床意义的改善。在第2年,使用阿巴西普和阿达木单抗治疗时,疲劳程度在100mm视觉模拟量表上分别改善了23.4mm和21.5mm。临床反应者的PROs改善程度高于无反应者。
在初治的活动性RA患者中,尽管之前使用过MTX,但联合MTX作为背景治疗的SC阿巴西普或阿达木单抗治疗在PROs方面产生了可比的改善,且与医生报告的临床反应终点高度相关。