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Etanercept in patients with inflammatory hand osteoarthritis (EHOA) : a multicentre, randomised, double-blind, placebo-controlled trial

(2018) ANNALS OF THE RHEUMATIC DISEASES. 77(12). p.1757-1764
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Abstract
Objective: Hand osteoarthritis is a prevalent disease with limited treatment options. Since joint inflammation is often present, we investigated tumour necrosis factor (TNF) as treatment target in patients with proven joint inflammation in a proof-of-concept study. Methods: T his 1-year, double-blind, randomised, multicentre trial (NTR1192) enrolled patients with symptomatic erosive inflammatory hand osteoarthritis. Patients flaring after non-steroidal anti-inflammatory drug washout were randomised to etanercept (24 weeks 50 mg/week, thereafter 25 mg/week) or placebo. The primary outcome was Visual Analogue Scale (VAS) pain at 24 weeks. Secondary outcomes included clinical and imaging outcomes (radiographs scored using Ghent University Scoring System (GUSS, n=54) and MRIs (n=20)). Results: O f 90 patients randomised to etanercept (n=45) or placebo (n=45), respectively, 12 and 10 discontinued prematurely. More patients on placebo discontinued due to inefficacy (6 vs 3), but fewer due to adverse effects (1 vs 6). The mean between-group difference (MD) in VAS pain was not statistically significantly different (-5.7 (95% CI -15.9 to 4.5), p=0.27 at 24 weeks; -8.5 (95% CI -18.6 to 1.6), p=0.10 at 1 year; favouring etanercept). In prespecified per-protocol analyses of completers with pain and inflammation at baseline (n=61), MD was -11.8 (95% CI -23.0 to -0.5) (p=0.04) at 1 year. Etanercept-treated joints showed more radiographic remodelling (delta GUSS: MD 2.9 (95% CI 0.5 to 5.4), p=0.02) and less MRI bone marrow lesions (MD -0.22 (95% CI -0.35 to -0.09), p =0.001); this was more pronounced in joints with baseline inflammation. Conclusion: Anti-TNF did not relieve pain effectively after 24 weeks in erosive osteoarthritis. Small subgroup analyses showed a signal for effects on subchondral bone in actively inflamed joints, but future studies to confirm this are warranted.
Keywords
INTERPHALANGEAL FINGER JOINTS, BONE-MARROW LESIONS, KNEE PAIN, EROSIVE, OSTEOARTHRITIS, SCORING SYSTEM, DISEASE, RECOMMENDATIONS, INHIBITION, SYNOVITIS, EFFICACY

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MLA
Kloppenburg, Margreet et al. “Etanercept in Patients with Inflammatory Hand Osteoarthritis (EHOA) : a Multicentre, Randomised, Double-blind, Placebo-controlled Trial.” ANNALS OF THE RHEUMATIC DISEASES 77.12 (2018): 1757–1764. Print.
APA
Kloppenburg, M., Ramonda, R., Bobacz, K., Kwok, W.-Y., Elewaut, D., Huizinga, T. W., Kroon, F. P., et al. (2018). Etanercept in patients with inflammatory hand osteoarthritis (EHOA) : a multicentre, randomised, double-blind, placebo-controlled trial. ANNALS OF THE RHEUMATIC DISEASES, 77(12), 1757–1764.
Chicago author-date
Kloppenburg, Margreet, Roberta Ramonda, Klaus Bobacz, Wing-Yee Kwok, Dirk Elewaut, Tom WJ Huizinga, Feline PB Kroon, et al. 2018. “Etanercept in Patients with Inflammatory Hand Osteoarthritis (EHOA) : a Multicentre, Randomised, Double-blind, Placebo-controlled Trial.” Annals of the Rheumatic Diseases 77 (12): 1757–1764.
Chicago author-date (all authors)
Kloppenburg, Margreet, Roberta Ramonda, Klaus Bobacz, Wing-Yee Kwok, Dirk Elewaut, Tom WJ Huizinga, Feline PB Kroon, Leonardo Punzi, Josef S Smolen, Bert Vander Cruyssen, Ron Wolterbeek, August Verbruggen, and Ruth Wittoek. 2018. “Etanercept in Patients with Inflammatory Hand Osteoarthritis (EHOA) : a Multicentre, Randomised, Double-blind, Placebo-controlled Trial.” Annals of the Rheumatic Diseases 77 (12): 1757–1764.
Vancouver
1.
Kloppenburg M, Ramonda R, Bobacz K, Kwok W-Y, Elewaut D, Huizinga TW, et al. Etanercept in patients with inflammatory hand osteoarthritis (EHOA) : a multicentre, randomised, double-blind, placebo-controlled trial. ANNALS OF THE RHEUMATIC DISEASES. 2018;77(12):1757–64.
IEEE
[1]
M. Kloppenburg et al., “Etanercept in patients with inflammatory hand osteoarthritis (EHOA) : a multicentre, randomised, double-blind, placebo-controlled trial,” ANNALS OF THE RHEUMATIC DISEASES, vol. 77, no. 12, pp. 1757–1764, 2018.
@article{8600952,
  abstract     = {Objective: Hand osteoarthritis is a prevalent disease with limited treatment options. Since joint inflammation is often present, we investigated tumour necrosis factor (TNF) as treatment target in patients with proven joint inflammation in a proof-of-concept study. 
Methods: T his 1-year, double-blind, randomised, multicentre trial (NTR1192) enrolled patients with symptomatic erosive inflammatory hand osteoarthritis. Patients flaring after non-steroidal anti-inflammatory drug washout were randomised to etanercept (24 weeks 50 mg/week, thereafter 25 mg/week) or placebo. The primary outcome was Visual Analogue Scale (VAS) pain at 24 weeks. Secondary outcomes included clinical and imaging outcomes (radiographs scored using Ghent University Scoring System (GUSS, n=54) and MRIs (n=20)). 
Results: O f 90 patients randomised to etanercept (n=45) or placebo (n=45), respectively, 12 and 10 discontinued prematurely. More patients on placebo discontinued due to inefficacy (6 vs 3), but fewer due to adverse effects (1 vs 6). The mean between-group difference (MD) in VAS pain was not statistically significantly different (-5.7 (95% CI -15.9 to 4.5), p=0.27 at 24 weeks; -8.5 (95% CI -18.6 to 1.6), p=0.10 at 1 year; favouring etanercept). In prespecified per-protocol analyses of completers with pain and inflammation at baseline (n=61), MD was -11.8 (95% CI -23.0 to -0.5) (p=0.04) at 1 year. Etanercept-treated joints showed more radiographic remodelling (delta GUSS: MD 2.9 (95% CI 0.5 to 5.4), p=0.02) and less MRI bone marrow lesions (MD -0.22 (95% CI -0.35 to -0.09), p =0.001); this was more pronounced in joints with baseline inflammation. 
Conclusion: Anti-TNF did not relieve pain effectively after 24 weeks in erosive osteoarthritis. Small subgroup analyses showed a signal for effects on subchondral bone in actively inflamed joints, but future studies to confirm this are warranted.},
  author       = {Kloppenburg, Margreet and Ramonda, Roberta and Bobacz, Klaus and Kwok, Wing-Yee and Elewaut, Dirk and Huizinga, Tom WJ and Kroon, Feline PB and Punzi, Leonardo and Smolen, Josef S and Vander Cruyssen, Bert and Wolterbeek, Ron and Verbruggen, August and Wittoek, Ruth},
  issn         = {0003-4967},
  journal      = {ANNALS OF THE RHEUMATIC DISEASES},
  keywords     = {INTERPHALANGEAL FINGER JOINTS,BONE-MARROW LESIONS,KNEE PAIN,EROSIVE,OSTEOARTHRITIS,SCORING SYSTEM,DISEASE,RECOMMENDATIONS,INHIBITION,SYNOVITIS,EFFICACY},
  language     = {eng},
  number       = {12},
  pages        = {1757--1764},
  title        = {Etanercept in patients with inflammatory hand osteoarthritis (EHOA) : a multicentre, randomised, double-blind, placebo-controlled trial},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2018-213202},
  volume       = {77},
  year         = {2018},
}

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