RT Journal Article SR Electronic T1 Less Radiographic Progression with Adalimumab Plus Methotrexate Versus Methotrexate Monotherapy Across the Spectrum of Clinical Response in Early Rheumatoid Arthritis JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.081018 DO 10.3899/jrheum.081018 A1 Paul Emery A1 Mark C. Genovese A1 Ronald van Vollenhoven A1 John T. Sharp A1 Kaushik Patra A1 Eric H. Sasso YR 2009 UL http://www.jrheum.org/content/early/2009/04/14/jrheum.081018.abstract AB Objective To determine the relationship between radiographic progression and clinical response for adalimumab plus methotrexate (MTX) versus either monotherapy in patients with early rheumatoid arthritis (RA) in the PREMIER study. Methods Patients with early RA who received adalimumab plus MTX (n = 240), adalimumab (n = 222), or MTX (n = 216) were grouped by American College of Rheumatology (ACR) response, 28-joint Disease Activity Score (DAS28), or remission-like state [tender joint count (TJC) = 0; DAS28 < 2.6; swollen joint count = 0;ACR100] at 26 and 104 weeks. Radiographic progression was assessed by cumulative probability plots, mean changes in total Sharp score (ΔTSS), and percentages of progressors (ΔTSS > 0.5). Results Across the spectrum of clinical outcomes, including ACR20 nonresponses and remission- like responses, therapy with adalimumab plus MTX permitted less radiographic progression at Weeks 26 and 104 than MTX monotherapy. Adalimumab monotherapy was generally intermediate. A strong, proportional relationship was observed between clinical response and radiographic efficacy only for MTX monotherapy. The monotherapies approximated the radiographic efficacy of adalimumab plus MTX only among remission-like responders, although progression was significantly greater with MTX monotherapy versus adalimumab plus MTX for patients with TJC = 0. Concurrent clinical (DAS28 < 2.6) and radiographic (ΔTSS ≤ 0.5) remission was significantly more frequent at Week 104 with adalimumab plus MTX (45%) than with adalimumab (25%) or MTX (18%) monotherapy. Conclusion In patients with early RA, adalimumab plus MTX resulted in less radiographic progression than MTX monotherapy across the spectrum of clinical response, including ACR20 nonresponses and remission-like responses.