Patients with active psoriatic arthritis receiving monthly subcutaneous injections of Golimumab ( CNTO 148 ) experienced significant and sustained improvements in the joint and skin manifestations of the disease, according to findings from the largest Phase 3 biologic study ever completed in subjects with psoriatic arthritis.
Findings presented at the showed that at week 14 of the 405-patient study in subjects with active psoriatic arthritis, 51 percent of patients receiving Golimumab 50 mg and 45 percent of patients receiving Golimumab 100 mg experienced at least 20 percent improvement in arthritis signs and symptoms ( ACR 20 ) compared with 9 percent of patients receiving placebo ( P < 0.001 for both comparisons ).
Golimumab-treated patients maintained significant improvements in arthritis through week 24 and also showed substantial and sustained improvements in skin and nail psoriatic disease (as measured by a 75 percent reduction in Psoriasis Area and Severity Index [ PASI 75 ] in patients with baseline body surface area with psoriasis of at least three percent, and the Nail Psoriasis Severity Index [ NAPSI ] ).
Golimumab is a human anti-tumor necrosis factor ( TNF )-alpha monoclonal antibody.
GO-REVEAL Trial
The Golimumab - A Randomized Evaluation of Safety and Efficacy in Subjects with Psoriatic Arthritis Using a Human Anti-TNF Monoclonal Antibody ( GO-REVEAL ) trial involved 405 adults with psoriatic arthritis. Subjects with at least three swollen and tender joints and active psoriatic skin lesions of at least 2 cm in diameter were randomly assigned to receive subcutaneous injections of placebo or Golimumab ( 50 or 100 mg ) at weeks 0, 4, 8, 12, 16 and 20.
At week 16, patients with inadequate arthritis response were switched to Golimumab 50 mg ( patients originally receiving placebo ) or Golimumab 100 mg ( patients originally receiving Golimumab 50 mg ).
The primary endpoint was ACR 20 response at week 14 for combined Golimumab groups and individual Golimumab dose groups versus placebo.
Joint and psoriatic improvements
Initial improvements as measured by ACR 20 at week 14 persisted through six months. At week 24, 52 percent and 61 percent of patients receiving Golimumab 50 mg and Golimumab 100 mg, respectively, achieved ACR 20, compared with 12 percent of patients receiving placebo ( P < 0.001 ).
Significant improvements were observed in ACR 50 and ACR 70 measures at the same time points.
At week 14, 30 percent and 28 percent of patients receiving Golimumab 50 mg and Golimumab 100 mg, respectively, achieved ACR 50, compared with 2 percent of patients receiving placebo ( P < 0.001 ).
ACR 70, a more stringent response criterion, was achieved at week 14 by 12 percent of patients receiving Golimumab 50 mg and 17 percent receiving Golimumab 100 mg, compared with 1 percent of patients receiving placebo ( P < 0.001 ).
At week 24, 19 percent of patients receiving Golimumab 50 mg and 21 percent of patients receiving Golimumab 100 mg achieved ACR 70 as compared with 1 percent of patients receiving placebo ( P < 0.001 ).
Patients receiving both doses of Golimumab also experienced improvements in enthesitis and dactylitis, two common disease manifestations causing pain and swelling.
Enthesitis, an inflammation of a tendon, ligament or joint capsule insertion to the bone and dactylitis, a swelling of digits in the hands or feet, are estimated to affect more than one-third of people with psoriatic arthritis.
At baseline, 78 percent ( placebo group ), 75 percent ( Golimumab 50 mg group ) and 79 percent ( Golimumab 100 mg group ) of study subjects presented with enthesitis ( at least one tender body enthesitis site ) as measured by the Maastricht Ankylosing Spondylitis Enthesitis Score ( MASES ) index modified for Psoriatic Arthritis; 34 percent ( placebo group ), 34 percent ( Golimumab 50 mg group ) and 34 percent ( Golimumab 100 mg group ) of subjects presented with dactylitis at baseline.
Both Golimumab doses were significantly better than placebo in improvement of enthesitis as measured by percent change in the psoriatic arthritis modified MASES Index.
At week 14, the mean improvement in enthesitis was 44 percent among patients receiving Golimumab 50 mg and 33 percent among patients receiving Golimumab 100 mg, compared with a 19 percent worsening in patients receiving placebo ( P < 0.001 ).
At week 24, the mean improvements in enthesitis were 46 percent for patients receiving Golimumab 50 mg and 52 percent among patients receiving Golimumab 100 mg, compared with a 13 percent worsening in placebo patients ( P < 0.001 ).
The Golimumab 100 mg dose significantly improved dactylitis measured by percent change in dactylitis score compared with placebo at week 14 ( 66 percent versus 5 percent; P = 0.009 ) and at week 24 ( 82 percent versus 28 percent; P < 0.001 ).
There was a trend towards improvement in dactylitis for 50 mg Golimumab dose at week 14 and 24 but the comparisons with placebo did not reach statistical significance.
In addition to improvements in joint symptoms, a substantial proportion of Golimumab-treated patients experienced significant improvement in skin manifestations of the disease.
Among a subset of the study population with at least three percent of body surface area involved by psoriasis at baseline, 40 percent and 58 percent of patients receiving Golimumab 50 mg and Golimumab 100 mg, respectively, achieved PASI 75 at week 14, compared with 3 percent of patients receiving placebo ( P < 0.001 ).
At week 24, PASI 75 responses improved to 56 percent ( Golimumab 50 mg ) and 66 percent ( Golimumab 100 mg ), compared with 1 percent of placebo patients ( P < 0.001 ).
In additional analyses, patients receiving Golimumab 50 mg and Golimumab 100 also experienced improvements in nail psoriasis as measured by NAPSI and these improvements were sustained over time.
Disease activity and physical function improvements
The majority of Golimumab-treated patients in the study were classified as good or moderate responders as measured by the Disease Activity Score 28 ( DAS28 ), which measures tender and swollen joints and overall disease activity including measurement of serum C-reactive protein ( CRP ) levels.
After 14 weeks of treatment, 66 percent of patients receiving Golimumab 50 mg were DAS28 responders, as were 67 percent of patients receiving the 100 mg dose, compared with 24 percent of patients receiving placebo ( P < 0.001 ).
At week 24, 64 percent and 78 percent of patients receiving Golimumab 50 mg and 100 mg, respectively, were DAS28 responders, compared with 24 percent of patients receiving placebo ( P < 0.001 ).
Patients receiving Golimumab in the study also experienced significant improvements in physical function, as measured by the Health Assessment Questionnaire ( HAQ ).
At week 14, patients receiving Golimumab 50 mg experienced a mean improvement of 0.31 and patients receiving Golimumab 100 mg experienced a mean improvement of 0.38 in HAQ score, compared with an improvement of only 0.04 among placebo patients ( P < 0.001 ).
At week 24, the improvements were 0.33 and 0.39 in the respective treatment groups, compared with worsening in HAQ score of -0.01 among patients receiving placebo ( P < 0.001 ).
HAQ assesses the degree of difficulty a patient has in accomplishing tasks in eight functional areas ( dressing, arising, eating, walking, hygiene, reaching, gripping and other activities of daily living ). An improvement in HAQ of at least 0.3 indicates clinically meaningful improvement in physical function.
Through week 24, the placebo-controlled portion of the study, Golimumab was generally well-tolerated, with two percent of Golimumab-treated patients experiencing serious adverse events compared with six percent of patients in the placebo group.
Injection site reactions occurred in five percent of patients receiving Golimumab and three percent of patients receiving placebo.
One case of prostate cancer and two cases of basal cell carcinoma were reported in Golimumab-treated patients.
There were no reports of tuberculosis or opportunistic infections through week 24.
Source: American College of Rheumatology ( ACR ) - Annual Scientific Meeting, 2007
XagenaMedicine2007
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