a The First Department of Internal Medicine , School of Medicine, University of Occupational and Environmental Health, Japan , Kitakyushu , Japan .
b Department of Pharmacovigilance , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan .
Mod Rheumatol. 2016 Jul;26(4):481-90. doi: 10.3109/14397595.2015.1109762. Epub 2015 Dec 23.
To evaluate the safety and efficacy of golimumab + methotrexate (MTX) in Japanese patients with active rheumatoid arthritis (RA).
Japanese patients with active RA despite MTX were randomized to placebo + MTX (Group 1, n = 88), golimumab 50 mg + MTX (Group 2, n = 86), or golimumab 100 mg + MTX (Group 3, n = 87). Patients with <20% improvement in swollen/tender joint counts entered early escape at week 16. At week 24, all remaining placebo patients crossed over to golimumab 50 mg. Efficacy assessments included ACR20, DAS28-ESR, and HAQ-DI. Radiographic progression was assessed with the van der Heijde-modified Sharp (vdH-S) score.
ACR20 response rates in Group 1, Group 2, and Group 3 were 67.9, 86.1, and 82.4%, respectively, at week 52 and were maintained through week 104 (87.1, 94.0, and 88.7%) and week 156 (97.1, 94.1, and 89.5%). Proportions of patients with good/moderate DAS28-ESR response or clinically meaningful improvement in HAQ-DI were also maintained through week 156. The majority of patients did not experience radiographic progression through week 156. Among 257 golimumab-treated patients, 251 (97.7%) had ≥1 AE; 54 (21.0%) had ≥1 serious AE through week 156. Infections were the most common type of AE.
Response to golimumab + MTX was maintained over 3 years in Japanese patients with active RA despite MTX. Safety results were consistent with the known safety profile of golimumab.
评估戈利木单抗联合甲氨蝶呤(MTX)在日本活动性类风湿关节炎(RA)患者中的安全性和疗效。
对接受 MTX 治疗后仍处于活动期的日本 RA 患者进行随机分组,分别接受安慰剂联合 MTX(第 1 组,n=88)、戈利木单抗 50mg 联合 MTX(第 2 组,n=86)或戈利木单抗 100mg 联合 MTX(第 3 组,n=87)治疗。治疗 16 周时,关节肿胀/压痛计数改善<20%的患者可早期交叉至戈利木单抗 50mg 组。第 24 周时,所有剩余的安慰剂组患者交叉至戈利木单抗 50mg 组。主要疗效评估指标包括 ACR20、DAS28-ESR 和 HAQ-DI。采用改良后的 Sharp 评分(vdH-S)评估影像学进展。
第 1 组、第 2 组和第 3 组患者在第 52 周时的 ACR20 缓解率分别为 67.9%、86.1%和 82.4%,在第 104 周(87.1%、94.0%和 88.7%)和第 156 周(97.1%、94.1%和 89.5%)时仍得以维持。DAS28-ESR 缓解良好/中度和 HAQ-DI 有临床意义改善的患者比例在第 156 周时也得以维持。至第 156 周时,大多数患者未发生影像学进展。在 257 例接受戈利木单抗治疗的患者中,251 例(97.7%)至少发生 1 例不良事件;54 例(21.0%)至第 156 周时至少发生 1 例严重不良事件。感染是最常见的不良事件类型。
在接受 MTX 治疗后仍处于活动期的日本 RA 患者中,戈利木单抗联合 MTX 治疗的应答可维持 3 年以上。安全性结果与戈利木单抗已知的安全性特征一致。