RA remission almost doubled if patients given combination treatment: COMET

Rheumatoid arthritis patients treated with a combination of methotrexate and etanercept, rather than methotrexate alone, are almost twice as likely to achieve remission, according to the one-year results from the COMET study. The Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET) study randomised 542 patients -  who were methotrexate-naive and had early moderate-to-severe RA for between and 24 months - to either methotrexate alone (n=268) or methotrexate plus etanercept 50 mg a week (n=274). In both groups methotrexate was titrated up from 7·5 mg a week to a maximum of 20 mg a week by week eight. Of 265 patients allocated to combination therapy who were available for evaluation, 132 (50%, 95% confidence interval [CI], 44% - 56%) achieved clinical remission, as did 73 (28%) of 263 patients (95% CI, 23% - 33%) taking methotrexate alone (effect difference, 22.05%; 95% CI, 13.96% - 30.15%; P < .0001). Overall, 132 (50%) of the patients allocated combined treatment and were available for assessment achieved clinical remission compared with 73 (28%) taking methotrexate alone (p<0·0001). Radiographic non-progression occurred in 80% of those allocated combined treatment that were available for assessment, compared with 59% of those taking methotrexate alone (p<0·0001). The authors also report that serious adverse events were similar between both groups. "Both clinical remission and radiographic non-progression are achievable goals in patients with early severe rheumatoid arthritis within 1 year of combined treatment with etanercept plus methotrexate," the study authors write. They add, "The positive clinical outcomes in the combination-treatment group also seem to determine the ability of patients to remain in employment. Furthermore, these outcomes appear to be achieved without exposing patients to significant additional risk." Reference Emery, P. Breedveld, F. Hall, S. et al. 2008, ‘Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial’ The Lancet. Online First. Volume and edition to be released....