Three year data on Humira and Methotrexate vs Humira alone.

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Background:
Anti-drug antibodies (ADA) are formed in patients treated with adalimumab (ADL). This might increase clearance of ADL, potentially causing a (secondary) non-response. Combination therapy of ADL and methotrexate (MTX) reduces ADA levels and has a clinical benefit in rheumatologic diseases. In psoriasis however, the long-term effectiveness and safety have not been studied.

Objectives:
To investigate the three-year follow up data of ADL combined with MTX compared to ADL monotherapy in ADL-naive patients with moderate to severe plaque type psoriasis.

Methods:
We conducted a multicentre RCT in the Netherlands and Belgium. Randomisation was performed by a centralised online randomisation service. Patients were seen every 12 weeks until week 145. Outcome assessors were blinded. We collected data on drug survival, effectiveness, safety, pharmacokinetics and immunogenicity of patients that started ADL combined with MTX compared to ADL monotherapy. We present descriptive analysis and patients were analysed according to the group initially randomised to. Patients becoming non-adherent to the biologic were excluded from analyses.

Results:
Sixty-one patients were included and 37 patients (ADL group n=17, ADL+MTX group n=20) continued in the follow-up study after one year. After 109 weeks and 145 weeks, there was a trend towards longer drug survival in the ADL+MTX group compared to the ADL group (week 109: 54.8% vs. 41.4%; p=0.326, week 145: 51.6% vs. 41.4%; p=0.464). At week 145, 7/13 patients were treated with MTX. In the ADL group, 4/12 patients that completed the study developed ADA, and 3/13 in the ADL+MTX group.

Conclusions:
In this small study, there was no significant difference in ADL overall drug survival when it was initially combined with MTX, compared to ADL alone. Discontinuation due to adverse events was common in the combination group. To secure accessible healthcare, combination treatment of ADL and MTX can be considered in individual patients.

Source: onlinelibrary.wiley.com

*Early view funding unknown

Humira (adalimumab)

Methotrexate

I’ve read about this before, it sounds sensible however methotrexate stopped working for me even at 20mg the psoriasis was coming back fast, so it’d be interesting to see if it would be able to help me go for longer with bios since mine only seem to last a year to 18 months.

(Wed-05-04-2023, 17:08 PM)Turnedlight Wrote: I’ve read about this before, it sounds sensible however methotrexate stopped working for me even at 20mg the psoriasis was coming back fast, so it’d be interesting to see if it would be able to help me go for longer with bios since mine only seem to last a year to 18 months.

Yes I mentioned this before.. it is research conducted in the University Hospital in Amsterdam.

(Wed-05-04-2023, 17:08 PM)Turnedlight Wrote: I’ve read about this before, it sounds sensible however methotrexate stopped working for me even at 20mg the psoriasis was coming back fast, so it’d be interesting to see if it would be able to help me go for longer with bios since mine only seem to last a year to 18 months.

Most studies use TNFs with MTX. There's a larger study out there that suggests 20 to 25 mg dose is required for any real benefit. Unfortunately, that's not a sustainable dose outside two years. I don't see this being a real solution.

The real solution would be the pill form of the biologics. Unfortunately, most of these drugs failed because of toxicity... But there is one IL 17 pill that looks like it will survive.