Etanercept and Methotrexate in Combination or as Monotherapy in Psoriatic Arthritis
Primary Purpose
Psoriatic Arthritis
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Etanercept
Methotrexate
Placebo to Etanercept
Placebo to Methotrexate
Sponsored by
About this trial
This is an interventional treatment trial for Psoriatic Arthritis focused on measuring Psoriatic Arthritis, Arthritis, Psoriasis, Etanercept, Enbrel, Methotrexate, Minimal Disease Activity
Eligibility Criteria
Key Inclusion Criteria:
- Subject must have a diagnosis of psoriatic arthritis (PsA) by the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria.
- Subject has ≥ 3 tender and ≥ 3 swollen joints at screening and at baseline.
- Subject has an active psoriatic skin lesion
- Subject is naïve to etanercept and any other biologic for the treatment for PsA or psoriasis.
- Subject has no prior use of methotrexate for PsA.
- Subject has no history of tuberculosis
- Subject has a negative test for tuberculosis, hepatitis B and C.
Exclusion Criteria:
- Subject has known history of alcoholic hepatitis, nonalcoholic steatohepatitis or immunodeficiency syndromes, including human immunodeficiency virus (HIV) infection.
- Subject has any active infection (including chronic or localized infections) for which anti-infectives were indicated within 4 weeks prior to the first dose of investigational product.
- Subject has a serious infection, defined as requiring hospitalization or intravenous anti-infectives within 8 weeks prior to the first dose of investigational product.
Sites / Locations
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Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Experimental
Experimental
Arm Label
Methotrexate Monotherapy
Etanercept Monotherapy
Methotrexate + Etanercept
Arm Description
Participants received oral methotrexate 20 mg weekly plus placebo to etanercept subcutaneous injection once a week for 48 weeks.
Participants received etanercept 50 mg weekly by subcutaneous injection plus oral placebo to methotrexate for 48 weeks.
Participants received etanercept 50 mg a week by subcutaneous injection plus oral methotrexate 20 mg weekly for 48 weeks.
Outcomes
Primary Outcome Measures
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 24
A positive ACR20 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 20% improvement in 68 tender joint count;
≥ 20% improvement in 66 swollen joint count; and
≥ 20% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein concentration.
Secondary Outcome Measures
Percentage of Participants With a Minimal Disease Activity (MDA) Response at Week 24
Minimal Disease Activity (MDA) is a measure of low disease activity specific for psoriatic arthritis (PsA) that incorporates measures of joint and entheseal inflammation, skin disease, patient reported outcomes and functional disability to assess disease activity. Participants were classified as achieving MDA if they fulfilled 5 of the following 7 outcome measures:
Tender joint count (0-68) ≤ 1
Swollen joint count (0-66) ≤ 1
Body surface area (BSA) involvement with psoriasis (0% to 100%) ≤ 3%
Patient global assessment of joint pain VAS (0-100) ≤ 15
Patient global assessment of disease activity VAS (0-100) ≤ 20
HAQ-DI (0-3) ≤ 0.5
Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index (18 sites assessed for enthesitis with an overall score of 0 - 16) ≤ 1
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response Over Time
A positive ACR20 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 20% improvement in 68 tender joint count;
≥ 20% improvement in 66 swollen joint count; and
≥ 20% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein.
Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response Over Time
A positive ACR50 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 50% improvement in 68 tender joint count;
≥ 50% improvement in 66 swollen joint count; and
≥ 50% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein.
Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response Over Time
A positive ACR70 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 70% improvement in 68 tender joint count;
≥ 70% improvement in 66 swollen joint count; and
≥ 70% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein.
Change From Baseline in Tender Joint Count Over Time
The tender joint count is an assessment of the pain and/or tenderness of 68 joints using a 0 to 1 point scale (0 = none, 1 = present). The total tender joint count is calculated by summing the number of joints with present tenderness.
Change From Baseline in Swollen Joint Count Over Time
The swollen joint count is an assessment of the swelling of 66 joints using a 0 to 1 point scale (0 = none, 1 = present). The total swollen joint count is calculated by summing the number of joints with present swelling.
Change From Baseline in Physician Global Assessment of Disease Activity Over Time
A global assessment of the participant's arthritis assessed by the physician on a 100 mm visual analog scale (VAS) where 0 mm = No activity at all and 100 mm = Worst activity imaginable.
Change From Baseline in Patient Global Assessment of Disease Activity Over Time
A global assessment of the participant's arthritis, assessed by the participant on a 100 mm VAS where 0 mm = No arthritis activity at all and 100 mm = Worst arthritis activity imaginable.
Change From Baseline in Patient Global Assessment of Joint Pain Over Time
A global assessment of the severity of the participant's joint pain, assessed by the participant on a 100 mm VAS where 0 mm = No pain at all and 100 mm = Worst pain imaginable.
Change From Baseline in Health Assessment Questionnaire- Disability Index (HAQ-DI) Over Time
The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire consisting of 20 questions referring to eight domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and usual activities. Participants assessed their ability to do each task over the past week using the following response categories: without any difficulty (0); with some difficulty (1); with much difficulty (2); and unable to do (3). Scores on each task are summed and averaged to provide an overall score ranging from 0 to 3, where zero represents no disability and three very severe, high-dependency disability. Negative mean changes from Baseline in the overall score indicate improvement in functional ability.
Change From Baseline in C-reactive Protein Concentration Over Time
C-reactive protein (CRP) is a specific measure of inflammatory activity.
Percentage of Participants With a American Minimal Disease Activity (MDA) Response Over Time
Minimal Disease Activity (MDA) is a measure of low disease activity specific for psoriatic arthritis (PsA) that incorporates measures of joint and entheseal inflammation, skin disease, patient reported outcomes and functional disability to assess disease activity. Participants were classified as achieving MDA if they fulfilled 5 of the following 7 outcome measures:
Tender joint count (0-68) ≤ 1
Swollen joint count (0-66) ≤ 1
Body surface area (BSA) involvement with psoriasis (0% to 100%) ≤ 3%
Patient global assessment of joint pain VAS (0-100) ≤ 15
Patient global assessment of disease activity VAS (0-100) ≤ 20
HAQ-DI (0-3) ≤ 0.5
Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index (18 sites assessed for enthesitis with an overall score of 0 - 16) ≤ 1
Change From Baseline in Psoriatic Arthritis Disease Activity Score (PASDAS) Over Time
PASDAS is a measure of disease activity derived from the following variables:
Physician and patient global assessment of disease activity (assessed on a 0-100 VAS)
68 tender joint count
66 swollen joint count
Short Form-36 Questionnaire (SF-36) physical component summary (general health status on a scale from 0-100)
Tender dactylitis count (each digit assessed for tender dactylitis; total score 0-20)
Leeds enthesitis index (enthesitis assessed at 6 sites; total score of 0-6)
CRP level (mg/L)
The composite score is a weighted index where higher scores indicate more severe disease.
Change From Baseline in Clinical Disease Activity Index (CDAI) Over Time
The Clinical Disease Activity Index (CDAI) is a composite index that is calculated as the sum of the following items:
28 tender joint count,
28 swollen joint count,
Patient's Global Assessment of Disease Activity measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest;
Physician's Global Assessment of Disease Activity -measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest.
The CDAI score ranges from 0-76 where lower scores indicate less disease activity.
Change From Baseline in Simplified Disease Activity Index (SDAI) Over Time
The Simplified Disease Activity Index (SDAI) is a composite index that is calculated as the sum of the following items:
28 tender joint count,
28 swollen joint count,
Patient's Global Assessment of Disease Activity measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest;
Physician's Global Assessment of Disease Activity -measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest.
CRP
The SDAI score ranges from 0 to 86 with higher scores representing worse disease.
Change From Baseline in the Disease Activity Score 28 (DAS28) Over Time
The DAS28 measures the severity of disease at a specific time and is derived from the following variables:
28 tender joint count
28 swollen joint count
C-reactive protein (CRP)
Patient's global assessment of disease activity, measured on a 100 mm VAS, where 0 mm = lowest disease activity and 100 mm = highest.
DAS28(CRP) scores range from 0 to approximately 10, with the upper bound dependent on the highest possible level of CRP. A DAS28 score higher than 5.1 indicates high disease activity, a DAS28 score less than 3.2 indicates low disease activity, and a DAS28 score less than 2.6 indicates clinical remission.
Change From Baseline in Health Assessment Questionnaire- Disability Index (HAQ-DI) at Week 24
The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire consisting of 20 questions referring in 8 functional areas: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and usual activities. Participants assessed their ability to do each task over the past week using the following response categories: without any difficulty (0); with some difficulty (1); with much difficulty (2); and unable to do (3). Scores on each task are summed and averaged to provide an overall score ranging from 0 to 3, where zero represents no disability and three very severe, high-dependency disability. Negative mean changes from Baseline in the overall score indicate improvement in functional ability.
Change From Baseline in Medical Outcomes Health Survey Short Form 36 Items Version 2 (SF-36 v2) at Week 24
The SF-36 is a health-related survey that assesses participant's quality of life and consists of 36 questions covering 8 health domains. Two summary component scores are calculated: mental component summary score (MCS) and physical component summary score (PCS). The MCS consists of social functioning, vitality, mental health, and role-emotional scales and the PCS consists of physical functioning, bodily pain, role-physical, and general health scales. Each domain is scored by summing the individual items and transforming the scores into a 0 to 100 scale with higher scores indicating better health status or functioning.
Change From Baseline in Modified Nail Psoriasis Severity Index (mNAPSI) at Week 24
The modified NAPSI scale is a grading system for nail psoriasis that incorporates the following 7 clinical features:
pitting (scores 0-3, depending on the number of pits)
nail plate crumbling (scores 0-3, depending on the % of nail involvement)
onycholysis and oil drop dyschromia (scores 0-3, depending on the % of nail involvement)
leukonychia (0 = absent, 1 = present)
red spots in lunula (0 = absent, 1 = present)
nail bed hyperkeratosis (0 = absent, 1 = present)
splinter hemorrhages (0 = absent, 1 = present)
In participants with fingernails involved with psoriasis, each fingernail was scored at baseline to determine the worst fingernail (ie, the fingernail with the highest mNAPSI score). This fingernail was followed for the remainder of the study.
mNAPSI scores range from 0-13 where higher scores represent worse nail disease.
Percentage of Participants With Clear mNAPSI at Week 24
The modified NAPSI scale is a grading system for nail psoriasis that incorporates the following 7 clinical features:
pitting (scores 0-3, depending on the number of pits)
nail plate crumbling (scores 0-3, depending on the % of nail involvement)
onycholysis and oil drop dyschromia (scores 0-3, depending on the % of nail involvement)
leukonychia (0 = absent, 1 = present)
red spots in lunula (0 = absent, 1 = present)
nail bed hyperkeratosis (0 = absent, 1 = present)
splinter hemorrhages (0 = absent, 1 = present)
In participants with fingernails involved with psoriasis, each fingernail was scored at baseline to determine the worst fingernail (ie, the fingernail with the highest mNAPSI score). This fingernail was followed for the remainder of the study.
mNAPSI scores range from 0-13 where higher scores represent worse nail disease. Clear mNAPSI is defined as a score = 0.
Change From Baseline in Leeds Dactylitis Index (LDI) at Week 24
The Leeds dactylitis index quantitatively measures dactylitis using the circumference of involved digits and control digits and tenderness of involved digits. Digits affected by dactylitis are defined as those with a 10% difference in the ratio of circumference of the affected digit to the contralateral digit. The control digit is either the contralateral digit (digit on opposite hand or foot), or if the contralateral digit is also affected, values from a standard reference table. Tenderness of affected digits is assessed on a scale from 0 [none] to 3 [worst]. The ratio of circumference between an affected digit and the control digit is multiplied by the tenderness score for the affected digit. The results from each involved digit are summed to provide the final LDI. A higher LDI indicates worse dactylitis.
Percentage of Participants With Clear LDI at Week 24
The Leeds dactylitis index quantitatively measures dactylitis using the circumference of involved digits and control digits and tenderness of involved digits. Digits affected by dactylitis are defined as those with a 10% difference in the ratio of circumference of the affected digit to the contralateral digit. The control digit is either the contralateral digit (digit on opposite hand or foot), or if the contralateral digit is also affected, values from a standard reference table. Tenderness of affected digits is assessed on a scale from 0 [none] to 3 [worst]. The ratio of circumference between an affected digit and the control digit is multiplied by the tenderness score for the affected digit. The results from each involved digit are summed to provide the final LDI. A higher LDI indicates worse dactylitis.
Clear LDI is defined as a score = 0.
Change From Baseline in Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index at Week 24
The SPARCC enthesitis index assesses enthesitis at 18 sites for palpitation with a resultant total score of 0 to 16 (for scoring purposes, the inferior patella and tibial tuberosity are considered 1 site because of their anatomical proximity). Tenderness at each site is quantified on a dichotomous basis (0 = non-tender, 1 = tender). Entheses assessed are medial epicondyle (left and right), lateral epicondyle (left and right), supraspinatus insertion into greater tuberosity of humerus (left and right), greater trochanter (left and right), quadriceps insertion into superior border of patella (left and right), patellar ligament insertion into inferior pole of patella or tibial tubercle (left and right), Achilles tendon insertion into calcaneum (left and right), plantar fascia insertion into calcaneum (left and right). A higher count represents greater enthesitis burden.
Percentage of Participants With Clear SPARCC Enthesitis Index Score at Week 24
The SPARCC enthesitis index assesses enthesitis at 18 sites for palpitation with a resultant total score of 0 to 16 (for scoring purposes, the inferior patella and tibial tuberosity are considered 1 site because of their anatomical proximity). Tenderness at each site is quantified on a dichotomous basis (0 = non-tender, 1 = tender). Entheses assessed are medial epicondyle (left and right), lateral epicondyle (left and right), supraspinatus insertion into greater tuberosity of humerus (left and right), greater trochanter (left and right), quadriceps insertion into superior border of patella (left and right), patellar ligament insertion into inferior pole of patella or tibial tubercle (left and right), Achilles tendon insertion into calcaneum (left and right), plantar fascia insertion into calcaneum (left and right). A higher count represents greater enthesitis burden.
Clear SPARCC enthesitis is defined as a score = 0.
Percent Improvement From Baseline in the Percentage of Body Surface Area (BSA) Involved in Psoriasis at Week 24
The physician's assessment of the percentage of the participant's total body surface area involved with psoriasis.
Percent improvement from baseline = (Baseline Value - Post-baseline Value) / Baseline * 100
Percent Improvement From Baseline in the Percentage of Body Surface Area (BSA) Involved in Psoriasis by Baseline BSA Involvement Subgroups
The physician's assessment of the percentage of the participant's total body surface area involved with psoriasis.
Percent improvement from baseline = (Baseline Value - Post-baseline Value) / Baseline * 100
Static Physician Global Assessment (sPGA) at Week 24
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Static Physician Global Assessment (sPGA) at Week 24 by Baseline BSA Involvement Subgroups
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Mean Static Physician Global Assessment (sPGA) Score at Week 24
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Mean Static Physician Global Assessment (sPGA) Score at Week 24 by Baseline BSA Involvement Subgroups
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Percentage of Participants With an sPGA Score of 0 (Clear) or 1 (Almost Clear) at Week 24
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Percentage of Participants With an sPGA Score of 0 (Clear) or 1 (Almost Clear) at Week 24 by Baseline BSA Involvement Subgroups
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Percentage of Participants With at Least a 1 Grade Improvement in sPGA From Baseline at Week 24
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Percentage of Participants With at Least a 1 Grade Improvement in sPGA From Baseline at Week 24 by Baseline BSA Involvement Subgroups
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Percentage of Participants With at Least a 2 Grade Improvement in sPGA From Baseline at Week 24
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Percentage of Participants With at Least a 2 Grade Improvement in sPGA From Baseline at Week 24 by Baseline BSA Involvement Subgroups
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02376790
Brief Title
Etanercept and Methotrexate in Combination or as Monotherapy in Psoriatic Arthritis
Official Title
A Multicenter Double-Blind, Randomized Controlled Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects With Psoriatic Arthritis
Study Type
Interventional
2. Study Status
Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
March 3, 2015 (Actual)
Primary Completion Date
January 9, 2018 (Actual)
Study Completion Date
July 6, 2018 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Amgen
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this study is to learn more about the role of etanercept alone or in combination with methotrexate on disease activity in adults with psoriatic arthritis.
Detailed Description
The study will consist of a 30-day screening period, a 48-week double-blind treatment period and a 30-day safety follow-up period.
At or after week 24, participants with an inadequate response could receive rescue therapy with etanercept plus methotrexate until the end of the treatment period.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Psoriatic Arthritis
Keywords
Psoriatic Arthritis, Arthritis, Psoriasis, Etanercept, Enbrel, Methotrexate, Minimal Disease Activity
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
851 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Methotrexate Monotherapy
Arm Type
Active Comparator
Arm Description
Participants received oral methotrexate 20 mg weekly plus placebo to etanercept subcutaneous injection once a week for 48 weeks.
Arm Title
Etanercept Monotherapy
Arm Type
Experimental
Arm Description
Participants received etanercept 50 mg weekly by subcutaneous injection plus oral placebo to methotrexate for 48 weeks.
Arm Title
Methotrexate + Etanercept
Arm Type
Experimental
Arm Description
Participants received etanercept 50 mg a week by subcutaneous injection plus oral methotrexate 20 mg weekly for 48 weeks.
Intervention Type
Drug
Intervention Name(s)
Etanercept
Other Intervention Name(s)
Enbrel
Intervention Description
Etanercept was administered by subcutaneous injection once a week
Intervention Type
Drug
Intervention Name(s)
Methotrexate
Intervention Description
Methotrexate capsules taken orally once a week. Dosing was initiated at 10 mg weekly and titrated up to a final dose of 20 mg weekly over a 4-week period.
Intervention Type
Drug
Intervention Name(s)
Placebo to Etanercept
Intervention Description
Placebo to etanercept was administered by subcutaneous injection once a week.
Intervention Type
Drug
Intervention Name(s)
Placebo to Methotrexate
Intervention Description
Placebo to methotrexate capsules taken orally once a week.
Primary Outcome Measure Information:
Title
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 24
Description
A positive ACR20 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 20% improvement in 68 tender joint count;
≥ 20% improvement in 66 swollen joint count; and
≥ 20% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein concentration.
Time Frame
Baseline and week 24
Secondary Outcome Measure Information:
Title
Percentage of Participants With a Minimal Disease Activity (MDA) Response at Week 24
Description
Minimal Disease Activity (MDA) is a measure of low disease activity specific for psoriatic arthritis (PsA) that incorporates measures of joint and entheseal inflammation, skin disease, patient reported outcomes and functional disability to assess disease activity. Participants were classified as achieving MDA if they fulfilled 5 of the following 7 outcome measures:
Tender joint count (0-68) ≤ 1
Swollen joint count (0-66) ≤ 1
Body surface area (BSA) involvement with psoriasis (0% to 100%) ≤ 3%
Patient global assessment of joint pain VAS (0-100) ≤ 15
Patient global assessment of disease activity VAS (0-100) ≤ 20
HAQ-DI (0-3) ≤ 0.5
Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index (18 sites assessed for enthesitis with an overall score of 0 - 16) ≤ 1
Time Frame
Week 24
Title
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response Over Time
Description
A positive ACR20 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 20% improvement in 68 tender joint count;
≥ 20% improvement in 66 swollen joint count; and
≥ 20% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response Over Time
Description
A positive ACR50 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 50% improvement in 68 tender joint count;
≥ 50% improvement in 66 swollen joint count; and
≥ 50% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response Over Time
Description
A positive ACR70 response is defined if the following 3 criteria for improvement from baseline were met:
≥ 70% improvement in 68 tender joint count;
≥ 70% improvement in 66 swollen joint count; and
≥ 70% improvement in at least 3 of the 5 following parameters:
Patient's assessment of joint pain (measured on a 100 mm visual analog scale [VAS]);
Patient's global assessment of disease activity (measured on a 100 mm VAS);
Physician's global assessment of disease activity (measured on a 100 mm VAS);
Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index [HAQ-DI]);
C-reactive protein.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Tender Joint Count Over Time
Description
The tender joint count is an assessment of the pain and/or tenderness of 68 joints using a 0 to 1 point scale (0 = none, 1 = present). The total tender joint count is calculated by summing the number of joints with present tenderness.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Swollen Joint Count Over Time
Description
The swollen joint count is an assessment of the swelling of 66 joints using a 0 to 1 point scale (0 = none, 1 = present). The total swollen joint count is calculated by summing the number of joints with present swelling.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Physician Global Assessment of Disease Activity Over Time
Description
A global assessment of the participant's arthritis assessed by the physician on a 100 mm visual analog scale (VAS) where 0 mm = No activity at all and 100 mm = Worst activity imaginable.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Patient Global Assessment of Disease Activity Over Time
Description
A global assessment of the participant's arthritis, assessed by the participant on a 100 mm VAS where 0 mm = No arthritis activity at all and 100 mm = Worst arthritis activity imaginable.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Patient Global Assessment of Joint Pain Over Time
Description
A global assessment of the severity of the participant's joint pain, assessed by the participant on a 100 mm VAS where 0 mm = No pain at all and 100 mm = Worst pain imaginable.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Health Assessment Questionnaire- Disability Index (HAQ-DI) Over Time
Description
The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire consisting of 20 questions referring to eight domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and usual activities. Participants assessed their ability to do each task over the past week using the following response categories: without any difficulty (0); with some difficulty (1); with much difficulty (2); and unable to do (3). Scores on each task are summed and averaged to provide an overall score ranging from 0 to 3, where zero represents no disability and three very severe, high-dependency disability. Negative mean changes from Baseline in the overall score indicate improvement in functional ability.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in C-reactive Protein Concentration Over Time
Description
C-reactive protein (CRP) is a specific measure of inflammatory activity.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Percentage of Participants With a American Minimal Disease Activity (MDA) Response Over Time
Description
Minimal Disease Activity (MDA) is a measure of low disease activity specific for psoriatic arthritis (PsA) that incorporates measures of joint and entheseal inflammation, skin disease, patient reported outcomes and functional disability to assess disease activity. Participants were classified as achieving MDA if they fulfilled 5 of the following 7 outcome measures:
Tender joint count (0-68) ≤ 1
Swollen joint count (0-66) ≤ 1
Body surface area (BSA) involvement with psoriasis (0% to 100%) ≤ 3%
Patient global assessment of joint pain VAS (0-100) ≤ 15
Patient global assessment of disease activity VAS (0-100) ≤ 20
HAQ-DI (0-3) ≤ 0.5
Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index (18 sites assessed for enthesitis with an overall score of 0 - 16) ≤ 1
Time Frame
Weeks 4, 8, 12, 24, 36, and 48
Title
Change From Baseline in Psoriatic Arthritis Disease Activity Score (PASDAS) Over Time
Description
PASDAS is a measure of disease activity derived from the following variables:
Physician and patient global assessment of disease activity (assessed on a 0-100 VAS)
68 tender joint count
66 swollen joint count
Short Form-36 Questionnaire (SF-36) physical component summary (general health status on a scale from 0-100)
Tender dactylitis count (each digit assessed for tender dactylitis; total score 0-20)
Leeds enthesitis index (enthesitis assessed at 6 sites; total score of 0-6)
CRP level (mg/L)
The composite score is a weighted index where higher scores indicate more severe disease.
Time Frame
Baseline and weeks 12, 24, 36, and 48
Title
Change From Baseline in Clinical Disease Activity Index (CDAI) Over Time
Description
The Clinical Disease Activity Index (CDAI) is a composite index that is calculated as the sum of the following items:
28 tender joint count,
28 swollen joint count,
Patient's Global Assessment of Disease Activity measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest;
Physician's Global Assessment of Disease Activity -measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest.
The CDAI score ranges from 0-76 where lower scores indicate less disease activity.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Simplified Disease Activity Index (SDAI) Over Time
Description
The Simplified Disease Activity Index (SDAI) is a composite index that is calculated as the sum of the following items:
28 tender joint count,
28 swollen joint count,
Patient's Global Assessment of Disease Activity measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest;
Physician's Global Assessment of Disease Activity -measured on a 10 cm VAS, where 0 cm = lowest disease activity and 10 cm = highest.
CRP
The SDAI score ranges from 0 to 86 with higher scores representing worse disease.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in the Disease Activity Score 28 (DAS28) Over Time
Description
The DAS28 measures the severity of disease at a specific time and is derived from the following variables:
28 tender joint count
28 swollen joint count
C-reactive protein (CRP)
Patient's global assessment of disease activity, measured on a 100 mm VAS, where 0 mm = lowest disease activity and 100 mm = highest.
DAS28(CRP) scores range from 0 to approximately 10, with the upper bound dependent on the highest possible level of CRP. A DAS28 score higher than 5.1 indicates high disease activity, a DAS28 score less than 3.2 indicates low disease activity, and a DAS28 score less than 2.6 indicates clinical remission.
Time Frame
Baseline and weeks 4, 8, 12, 16, 24, 36, and 48
Title
Change From Baseline in Health Assessment Questionnaire- Disability Index (HAQ-DI) at Week 24
Description
The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire consisting of 20 questions referring in 8 functional areas: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and usual activities. Participants assessed their ability to do each task over the past week using the following response categories: without any difficulty (0); with some difficulty (1); with much difficulty (2); and unable to do (3). Scores on each task are summed and averaged to provide an overall score ranging from 0 to 3, where zero represents no disability and three very severe, high-dependency disability. Negative mean changes from Baseline in the overall score indicate improvement in functional ability.
Time Frame
Baseline and week 24
Title
Change From Baseline in Medical Outcomes Health Survey Short Form 36 Items Version 2 (SF-36 v2) at Week 24
Description
The SF-36 is a health-related survey that assesses participant's quality of life and consists of 36 questions covering 8 health domains. Two summary component scores are calculated: mental component summary score (MCS) and physical component summary score (PCS). The MCS consists of social functioning, vitality, mental health, and role-emotional scales and the PCS consists of physical functioning, bodily pain, role-physical, and general health scales. Each domain is scored by summing the individual items and transforming the scores into a 0 to 100 scale with higher scores indicating better health status or functioning.
Time Frame
Baseline and week 24
Title
Change From Baseline in Modified Nail Psoriasis Severity Index (mNAPSI) at Week 24
Description
The modified NAPSI scale is a grading system for nail psoriasis that incorporates the following 7 clinical features:
pitting (scores 0-3, depending on the number of pits)
nail plate crumbling (scores 0-3, depending on the % of nail involvement)
onycholysis and oil drop dyschromia (scores 0-3, depending on the % of nail involvement)
leukonychia (0 = absent, 1 = present)
red spots in lunula (0 = absent, 1 = present)
nail bed hyperkeratosis (0 = absent, 1 = present)
splinter hemorrhages (0 = absent, 1 = present)
In participants with fingernails involved with psoriasis, each fingernail was scored at baseline to determine the worst fingernail (ie, the fingernail with the highest mNAPSI score). This fingernail was followed for the remainder of the study.
mNAPSI scores range from 0-13 where higher scores represent worse nail disease.
Time Frame
Baseline and week 24
Title
Percentage of Participants With Clear mNAPSI at Week 24
Description
The modified NAPSI scale is a grading system for nail psoriasis that incorporates the following 7 clinical features:
pitting (scores 0-3, depending on the number of pits)
nail plate crumbling (scores 0-3, depending on the % of nail involvement)
onycholysis and oil drop dyschromia (scores 0-3, depending on the % of nail involvement)
leukonychia (0 = absent, 1 = present)
red spots in lunula (0 = absent, 1 = present)
nail bed hyperkeratosis (0 = absent, 1 = present)
splinter hemorrhages (0 = absent, 1 = present)
In participants with fingernails involved with psoriasis, each fingernail was scored at baseline to determine the worst fingernail (ie, the fingernail with the highest mNAPSI score). This fingernail was followed for the remainder of the study.
mNAPSI scores range from 0-13 where higher scores represent worse nail disease. Clear mNAPSI is defined as a score = 0.
Time Frame
Baseline and week 24
Title
Change From Baseline in Leeds Dactylitis Index (LDI) at Week 24
Description
The Leeds dactylitis index quantitatively measures dactylitis using the circumference of involved digits and control digits and tenderness of involved digits. Digits affected by dactylitis are defined as those with a 10% difference in the ratio of circumference of the affected digit to the contralateral digit. The control digit is either the contralateral digit (digit on opposite hand or foot), or if the contralateral digit is also affected, values from a standard reference table. Tenderness of affected digits is assessed on a scale from 0 [none] to 3 [worst]. The ratio of circumference between an affected digit and the control digit is multiplied by the tenderness score for the affected digit. The results from each involved digit are summed to provide the final LDI. A higher LDI indicates worse dactylitis.
Time Frame
Baseline and week 24
Title
Percentage of Participants With Clear LDI at Week 24
Description
The Leeds dactylitis index quantitatively measures dactylitis using the circumference of involved digits and control digits and tenderness of involved digits. Digits affected by dactylitis are defined as those with a 10% difference in the ratio of circumference of the affected digit to the contralateral digit. The control digit is either the contralateral digit (digit on opposite hand or foot), or if the contralateral digit is also affected, values from a standard reference table. Tenderness of affected digits is assessed on a scale from 0 [none] to 3 [worst]. The ratio of circumference between an affected digit and the control digit is multiplied by the tenderness score for the affected digit. The results from each involved digit are summed to provide the final LDI. A higher LDI indicates worse dactylitis.
Clear LDI is defined as a score = 0.
Time Frame
Baseline and week 24
Title
Change From Baseline in Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index at Week 24
Description
The SPARCC enthesitis index assesses enthesitis at 18 sites for palpitation with a resultant total score of 0 to 16 (for scoring purposes, the inferior patella and tibial tuberosity are considered 1 site because of their anatomical proximity). Tenderness at each site is quantified on a dichotomous basis (0 = non-tender, 1 = tender). Entheses assessed are medial epicondyle (left and right), lateral epicondyle (left and right), supraspinatus insertion into greater tuberosity of humerus (left and right), greater trochanter (left and right), quadriceps insertion into superior border of patella (left and right), patellar ligament insertion into inferior pole of patella or tibial tubercle (left and right), Achilles tendon insertion into calcaneum (left and right), plantar fascia insertion into calcaneum (left and right). A higher count represents greater enthesitis burden.
Time Frame
Baseline and week 24
Title
Percentage of Participants With Clear SPARCC Enthesitis Index Score at Week 24
Description
The SPARCC enthesitis index assesses enthesitis at 18 sites for palpitation with a resultant total score of 0 to 16 (for scoring purposes, the inferior patella and tibial tuberosity are considered 1 site because of their anatomical proximity). Tenderness at each site is quantified on a dichotomous basis (0 = non-tender, 1 = tender). Entheses assessed are medial epicondyle (left and right), lateral epicondyle (left and right), supraspinatus insertion into greater tuberosity of humerus (left and right), greater trochanter (left and right), quadriceps insertion into superior border of patella (left and right), patellar ligament insertion into inferior pole of patella or tibial tubercle (left and right), Achilles tendon insertion into calcaneum (left and right), plantar fascia insertion into calcaneum (left and right). A higher count represents greater enthesitis burden.
Clear SPARCC enthesitis is defined as a score = 0.
Time Frame
Baseline and week 24
Title
Percent Improvement From Baseline in the Percentage of Body Surface Area (BSA) Involved in Psoriasis at Week 24
Description
The physician's assessment of the percentage of the participant's total body surface area involved with psoriasis.
Percent improvement from baseline = (Baseline Value - Post-baseline Value) / Baseline * 100
Time Frame
Baseline and week 24
Title
Percent Improvement From Baseline in the Percentage of Body Surface Area (BSA) Involved in Psoriasis by Baseline BSA Involvement Subgroups
Description
The physician's assessment of the percentage of the participant's total body surface area involved with psoriasis.
Percent improvement from baseline = (Baseline Value - Post-baseline Value) / Baseline * 100
Time Frame
Baseline and week 24
Title
Static Physician Global Assessment (sPGA) at Week 24
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Week 24
Title
Static Physician Global Assessment (sPGA) at Week 24 by Baseline BSA Involvement Subgroups
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Week 24
Title
Mean Static Physician Global Assessment (sPGA) Score at Week 24
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Week 24
Title
Mean Static Physician Global Assessment (sPGA) Score at Week 24 by Baseline BSA Involvement Subgroups
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Week 24
Title
Percentage of Participants With an sPGA Score of 0 (Clear) or 1 (Almost Clear) at Week 24
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Week 24
Title
Percentage of Participants With an sPGA Score of 0 (Clear) or 1 (Almost Clear) at Week 24 by Baseline BSA Involvement Subgroups
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Week 24
Title
Percentage of Participants With at Least a 1 Grade Improvement in sPGA From Baseline at Week 24
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Baseline and week 24
Title
Percentage of Participants With at Least a 1 Grade Improvement in sPGA From Baseline at Week 24 by Baseline BSA Involvement Subgroups
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Baseline and week 24
Title
Percentage of Participants With at Least a 2 Grade Improvement in sPGA From Baseline at Week 24
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Baseline and week 24
Title
Percentage of Participants With at Least a 2 Grade Improvement in sPGA From Baseline at Week 24 by Baseline BSA Involvement Subgroups
Description
The static Physician Global Assessment of psoriasis (sPGA) evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The sPGA is assessed on a scale from 0 to 5:
0 = clear (no evidence of plaque elevation, erythema or scaling)
= almost clear (minimal plaque elevation, erythema or scaling)
= mild (mild plaque elevation or scaling, light red coloration)
= moderate (moderate plaque elevation, scaling, light red coloration)
= marked (marked plaque elevation, thick, non-tenacious scale predominates, bright red coloration)
= severe (severe plaque elevation, very thick tenacious scaling, dusky to deep red coloration).
Time Frame
Baseline and week 24
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria:
Subject must have a diagnosis of psoriatic arthritis (PsA) by the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria.
Subject has ≥ 3 tender and ≥ 3 swollen joints at screening and at baseline.
Subject has an active psoriatic skin lesion
Subject is naïve to etanercept and any other biologic for the treatment for PsA or psoriasis.
Subject has no prior use of methotrexate for PsA.
Subject has no history of tuberculosis
Subject has a negative test for tuberculosis, hepatitis B and C.
Exclusion Criteria:
Subject has known history of alcoholic hepatitis, nonalcoholic steatohepatitis or immunodeficiency syndromes, including human immunodeficiency virus (HIV) infection.
Subject has any active infection (including chronic or localized infections) for which anti-infectives were indicated within 4 weeks prior to the first dose of investigational product.
Subject has a serious infection, defined as requiring hospitalization or intravenous anti-infectives within 8 weeks prior to the first dose of investigational product.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
MD
Organizational Affiliation
Amgen
Official's Role
Study Director
Facility Information:
Facility Name
Research Site
City
Tuscaloosa
State/Province
Alabama
ZIP/Postal Code
35406
Country
United States
Facility Name
Research Site
City
Glendale
State/Province
Arizona
ZIP/Postal Code
85306
Country
United States
Facility Name
Research Site
City
Mesa
State/Province
Arizona
ZIP/Postal Code
85202
Country
United States
Facility Name
Research Site
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85258
Country
United States
Facility Name
Research Site
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72205
Country
United States
Facility Name
Research Site
City
Escondido
State/Province
California
ZIP/Postal Code
92025
Country
United States
Facility Name
Research Site
City
Hemet
State/Province
California
ZIP/Postal Code
92543
Country
United States
Facility Name
Research Site
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
Research Site
City
Mather
State/Province
California
ZIP/Postal Code
95655
Country
United States
Facility Name
Research Site
City
Palm Desert
State/Province
California
ZIP/Postal Code
92260
Country
United States
Facility Name
Research Site
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Research Site
City
Santa Monica
State/Province
California
ZIP/Postal Code
90404
Country
United States
Facility Name
Research Site
City
Thousand Oaks
State/Province
California
ZIP/Postal Code
91360
Country
United States
Facility Name
Research Site
City
Tustin
State/Province
California
ZIP/Postal Code
92780
Country
United States
Facility Name
Research Site
City
Aventura
State/Province
Florida
ZIP/Postal Code
33180
Country
United States
Facility Name
Research Site
City
Clearwater
State/Province
Florida
ZIP/Postal Code
33765
Country
United States
Facility Name
Research Site
City
Kissimmee
State/Province
Florida
ZIP/Postal Code
34741
Country
United States
Facility Name
Research Site
City
Ocoee
State/Province
Florida
ZIP/Postal Code
34761
Country
United States
Facility Name
Research Site
City
Tampa
State/Province
Florida
ZIP/Postal Code
33609
Country
United States
Facility Name
Research Site
City
Tampa
State/Province
Florida
ZIP/Postal Code
33613
Country
United States
Facility Name
Research Site
City
Zephyrhills
State/Province
Florida
ZIP/Postal Code
33542
Country
United States
Facility Name
Research Site
City
Meridian
State/Province
Idaho
ZIP/Postal Code
83642
Country
United States
Facility Name
Research Site
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Research Site
City
Springfield
State/Province
Illinois
ZIP/Postal Code
62703
Country
United States
Facility Name
Research Site
City
Bowling Green
State/Province
Kentucky
ZIP/Postal Code
42101
Country
United States
Facility Name
Research Site
City
Paducah
State/Province
Kentucky
ZIP/Postal Code
42003
Country
United States
Facility Name
Research Site
City
Frederick
State/Province
Maryland
ZIP/Postal Code
21702
Country
United States
Facility Name
Research Site
City
Hagerstown
State/Province
Maryland
ZIP/Postal Code
21740
Country
United States
Facility Name
Research Site
City
Wheaton
State/Province
Maryland
ZIP/Postal Code
20902
Country
United States
Facility Name
Research Site
City
Worcester
State/Province
Massachusetts
ZIP/Postal Code
01605
Country
United States
Facility Name
Research Site
City
Lansing
State/Province
Michigan
ZIP/Postal Code
48910
Country
United States
Facility Name
Research Site
City
Lansing
State/Province
Michigan
ZIP/Postal Code
48917
Country
United States
Facility Name
Research Site
City
Saint Clair Shores
State/Province
Michigan
ZIP/Postal Code
48081
Country
United States
Facility Name
Research Site
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Research Site
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89128
Country
United States
Facility Name
Research Site
City
Lebanon
State/Province
New Hampshire
ZIP/Postal Code
03756
Country
United States
Facility Name
Research Site
City
Clifton
State/Province
New Jersey
ZIP/Postal Code
07012
Country
United States
Facility Name
Research Site
City
Freehold
State/Province
New Jersey
ZIP/Postal Code
07728
Country
United States
Facility Name
Research Site
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87102
Country
United States
Facility Name
Research Site
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Facility Name
Research Site
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States
Facility Name
Research Site
City
Asheville
State/Province
North Carolina
ZIP/Postal Code
28803
Country
United States
Facility Name
Research Site
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28204
Country
United States
Facility Name
Research Site
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44109
Country
United States
Facility Name
Research Site
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73103
Country
United States
Facility Name
Research Site
City
Duncansville
State/Province
Pennsylvania
ZIP/Postal Code
16635
Country
United States
Facility Name
Research Site
City
Wyomissing
State/Province
Pennsylvania
ZIP/Postal Code
19610
Country
United States
Facility Name
Research Site
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29406
Country
United States
Facility Name
Research Site
City
Rapid City
State/Province
South Dakota
ZIP/Postal Code
57701
Country
United States
Facility Name
Research Site
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
Research Site
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78232
Country
United States
Facility Name
Research Site
City
Chesapeake
State/Province
Virginia
ZIP/Postal Code
23320
Country
United States
Facility Name
Research Site
City
Danville
State/Province
Virginia
ZIP/Postal Code
24541
Country
United States
Facility Name
Research Site
City
Roanoke
State/Province
Virginia
ZIP/Postal Code
24016
Country
United States
Facility Name
Research Site
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States
Facility Name
Research Site
City
Ciudad Autonoma de Buenos Aires
State/Province
Buenos Aires
ZIP/Postal Code
C1015ABO
Country
Argentina
Facility Name
Research Site
City
San Miguel de Tucuman
State/Province
Tucuman
ZIP/Postal Code
T4000AXL
Country
Argentina
Facility Name
Research Site
City
Buenos Aires
ZIP/Postal Code
1425
Country
Argentina
Facility Name
Research Site
City
Burgas
ZIP/Postal Code
8000
Country
Bulgaria
Facility Name
Research Site
City
Pleven
ZIP/Postal Code
5800
Country
Bulgaria
Facility Name
Research Site
City
Plovdiv
ZIP/Postal Code
4002
Country
Bulgaria
Facility Name
Research Site
City
Rouse
ZIP/Postal Code
7002
Country
Bulgaria
Facility Name
Research Site
City
Sofia
ZIP/Postal Code
1612
Country
Bulgaria
Facility Name
Research Site
City
Sofia
ZIP/Postal Code
1784
Country
Bulgaria
Facility Name
Research Site
City
Surrey
State/Province
British Columbia
ZIP/Postal Code
V3R 6A7
Country
Canada
Facility Name
Research Site
City
Winnipeg
State/Province
Manitoba
ZIP/Postal Code
R3N 0K6
Country
Canada
Facility Name
Research Site
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 3H7
Country
Canada
Facility Name
Research Site
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5T 2S8
Country
Canada
Facility Name
Research Site
City
Trois-Rivieres
State/Province
Quebec
ZIP/Postal Code
G8Z 1Y2
Country
Canada
Facility Name
Research Site
City
Saskatoon
State/Province
Saskatchewan
ZIP/Postal Code
S7K 3H3
Country
Canada
Facility Name
Research Site
City
Quebec
ZIP/Postal Code
G1V 3M7
Country
Canada
Facility Name
Research Site
City
Santiago
ZIP/Postal Code
7501126
Country
Chile
Facility Name
Research Site
City
Santiago
ZIP/Postal Code
7640881
Country
Chile
Facility Name
Research Site
City
Santiago
ZIP/Postal Code
8420383
Country
Chile
Facility Name
Research Site
City
Brno
ZIP/Postal Code
638 00
Country
Czechia
Facility Name
Research Site
City
Ostrava-Trebovice
ZIP/Postal Code
722 00
Country
Czechia
Facility Name
Research Site
City
Pardubice
ZIP/Postal Code
530 02
Country
Czechia
Facility Name
Research Site
City
Praha 2
ZIP/Postal Code
128 08
Country
Czechia
Facility Name
Research Site
City
Praha 2
ZIP/Postal Code
128 50
Country
Czechia
Facility Name
Research Site
City
Uherske Hradiste
ZIP/Postal Code
686 01
Country
Czechia
Facility Name
Research Site
City
Zlin
ZIP/Postal Code
760 01
Country
Czechia
Facility Name
Research Site
City
Lyon Cédex 3
ZIP/Postal Code
69437
Country
France
Facility Name
Research Site
City
Poitiers
ZIP/Postal Code
86000
Country
France
Facility Name
Research Site
City
Athens
ZIP/Postal Code
11521
Country
Greece
Facility Name
Research Site
City
Athens
ZIP/Postal Code
11527
Country
Greece
Facility Name
Research Site
City
Athens
ZIP/Postal Code
12462
Country
Greece
Facility Name
Research Site
City
Thessaloniki
ZIP/Postal Code
56429
Country
Greece
Facility Name
Research Site
City
Budapest
ZIP/Postal Code
1036
Country
Hungary
Facility Name
Research Site
City
Nyiregyhaza
ZIP/Postal Code
4400
Country
Hungary
Facility Name
Research Site
City
Szolnok
ZIP/Postal Code
5000
Country
Hungary
Facility Name
Research Site
City
Szombathely
ZIP/Postal Code
9700
Country
Hungary
Facility Name
Research Site
City
Veszprem
ZIP/Postal Code
8200
Country
Hungary
Facility Name
Research Site
City
Liepaja
ZIP/Postal Code
3401
Country
Latvia
Facility Name
Research Site
City
Riga
ZIP/Postal Code
1003
Country
Latvia
Facility Name
Research Site
City
Valmiera
ZIP/Postal Code
4201
Country
Latvia
Facility Name
Research Site
City
Mexicali
State/Province
Baja California Norte
ZIP/Postal Code
21100
Country
Mexico
Facility Name
Research Site
City
Mexicalli
State/Province
Baja California Norte
ZIP/Postal Code
21200
Country
Mexico
Facility Name
Research Site
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44650
Country
Mexico
Facility Name
Research Site
City
Zapopan
State/Province
Jalisco
ZIP/Postal Code
45190
Country
Mexico
Facility Name
Research Site
City
Monterrey
State/Province
Nuevo León
ZIP/Postal Code
64020
Country
Mexico
Facility Name
Research Site
City
Monterrey
State/Province
Nuevo León
ZIP/Postal Code
64718
Country
Mexico
Facility Name
Research Site
City
Culiacan
State/Province
Sinaloa
ZIP/Postal Code
80000
Country
Mexico
Facility Name
Research Site
City
Chihuahua
ZIP/Postal Code
31000
Country
Mexico
Facility Name
Research Site
City
Gdansk
ZIP/Postal Code
80-402
Country
Poland
Facility Name
Research Site
City
Lodz
ZIP/Postal Code
90-436
Country
Poland
Facility Name
Research Site
City
Warszawa
ZIP/Postal Code
01-817
Country
Poland
Facility Name
Research Site
City
Wroclaw
ZIP/Postal Code
50-368
Country
Poland
Facility Name
Research Site
City
Wroclaw
ZIP/Postal Code
51-318
Country
Poland
Facility Name
Research Site
City
Lisboa
ZIP/Postal Code
1050-034
Country
Portugal
Facility Name
Research Site
City
Lisboa
ZIP/Postal Code
1649-034
Country
Portugal
Facility Name
Research Site
City
Ponte de Lima
ZIP/Postal Code
4990-041
Country
Portugal
Facility Name
Research Site
City
Ponce
ZIP/Postal Code
00716
Country
Puerto Rico
Facility Name
Research Site
City
San Juan
ZIP/Postal Code
00918
Country
Puerto Rico
Facility Name
Research Site
City
Chelyabinsk
ZIP/Postal Code
454076
Country
Russian Federation
Facility Name
Research Site
City
Ekaterinburg
ZIP/Postal Code
620102
Country
Russian Federation
Facility Name
Research Site
City
Kemerovo
ZIP/Postal Code
650000
Country
Russian Federation
Facility Name
Research Site
City
Kursk
ZIP/Postal Code
305007
Country
Russian Federation
Facility Name
Research Site
City
Moscow
ZIP/Postal Code
115522
Country
Russian Federation
Facility Name
Research Site
City
Moscow
ZIP/Postal Code
119992
Country
Russian Federation
Facility Name
Research Site
City
Novosibirsk
ZIP/Postal Code
630005
Country
Russian Federation
Facility Name
Research Site
City
Orenburg
ZIP/Postal Code
460018
Country
Russian Federation
Facility Name
Research Site
City
Petrozavodsk
ZIP/Postal Code
185019
Country
Russian Federation
Facility Name
Research Site
City
Ryazan
ZIP/Postal Code
390026
Country
Russian Federation
Facility Name
Research Site
City
Saratov
ZIP/Postal Code
410053
Country
Russian Federation
Facility Name
Research Site
City
Smolensk
ZIP/Postal Code
214025
Country
Russian Federation
Facility Name
Research Site
City
Vladimir
ZIP/Postal Code
600023
Country
Russian Federation
Facility Name
Research Site
City
Yaroslavl
ZIP/Postal Code
150003
Country
Russian Federation
Facility Name
Research Site
City
Yaroslavl
ZIP/Postal Code
150062
Country
Russian Federation
Facility Name
Research Site
City
Panorama
State/Province
Western Cape
ZIP/Postal Code
7500
Country
South Africa
Facility Name
Research Site
City
Pinelands
State/Province
Western Cape
ZIP/Postal Code
7405
Country
South Africa
Facility Name
Research Site
City
Stellenbosch
State/Province
Western Cape
ZIP/Postal Code
7600
Country
South Africa
Facility Name
Research Site
City
Cordoba
State/Province
Andalucía
ZIP/Postal Code
14004
Country
Spain
Facility Name
Research Site
City
La Vila-Joiosa
State/Province
Comunidad Valenciana
ZIP/Postal Code
03570
Country
Spain
Facility Name
Research Site
City
Merida
State/Province
Extremadura
ZIP/Postal Code
06800
Country
Spain
Facility Name
Research Site
City
A Coruña
State/Province
Galicia
ZIP/Postal Code
15006
Country
Spain
Facility Name
Research Site
City
Bradford
ZIP/Postal Code
BD5 0NA
Country
United Kingdom
Facility Name
Research Site
City
Dudley
ZIP/Postal Code
DY1 2HQ
Country
United Kingdom
Facility Name
Research Site
City
Nottingham
ZIP/Postal Code
NG7 2UH
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
29531787
Citation
Mease PJ, Gladman DD, Samad AS, Coates LC, Liu LXH, Aras GA, Collier DH, Chung JB. Design and rationale of the Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects with Psoriatic Arthritis (SEAM-PsA). RMD Open. 2018 Feb 3;4(1):e000606. doi: 10.1136/rmdopen-2017-000606. eCollection 2018.
Results Reference
background
PubMed Identifier
30747501
Citation
Mease PJ, Gladman DD, Collier DH, Ritchlin CT, Helliwell PS, Liu L, Kricorian G, Chung JB. Etanercept and Methotrexate as Monotherapy or in Combination for Psoriatic Arthritis: Primary Results From a Randomized, Controlled Phase III Trial. Arthritis Rheumatol. 2019 Jul;71(7):1112-1124. doi: 10.1002/art.40851. Epub 2019 May 28.
Results Reference
background
PubMed Identifier
33452180
Citation
Strand V, Mease PJ, Maksabedian Hernandez EJ, Stolshek BS, Liu LXH, Collier DH, Kricorian G, Merola JF. Patient-reported outcomes data in patients with psoriatic arthritis from a randomised trial of etanercept and methotrexate as monotherapy or in combination. RMD Open. 2021 Jan;7(1):e001484. doi: 10.1136/rmdopen-2020-001484.
Results Reference
background
PubMed Identifier
32864685
Citation
Coates LC, Merola JF, Mease PJ, Ogdie A, Gladman DD, Strand V, van Mens LJJ, Liu L, Yen PK, Collier DH, Kricorian G, Chung JB, Helliwell PS. Performance of composite measures used in a trial of etanercept and methotrexate as monotherapy or in combination in psoriatic arthritis. Rheumatology (Oxford). 2021 Mar 2;60(3):1137-1147. doi: 10.1093/rheumatology/keaa271.
Results Reference
background
PubMed Identifier
35863864
Citation
Helliwell PS, Mease PJ, Kavanaugh A, Coates LC, Ogdie A, Deodhar A, Strand V, Kricorian G, Liu LXH, Collier D, Gladman DD. Impact of clinical domains other than arthritis on composite outcomes in psoriatic arthritis: comparison of treatment effects in the SEAM-PsA trial. RMD Open. 2022 Jul;8(2):e002366. doi: 10.1136/rmdopen-2022-002366.
Results Reference
background
Links:
URL
http://www.amgentrials.com
Description
AmgenTrials clinical trials website
Learn more about this trial
Etanercept and Methotrexate in Combination or as Monotherapy in Psoriatic Arthritis
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