Authors' reply

摘要

We appreciate the comments by David Felson on our report. In addition to evaluating remission-defined as disease activity score using 28 joints (DAS28) of less than 2.6-we did exploratory post-hoc analyses to assess clinical disease activity index (CDAI), simplified disease activity index (SDAI), and American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean-based remission rates. Consistent with results using remission defined as DAS28 of less than 2.6, more patients who received tocilizumab achieved remission using these alternative criteria than patients who received adalimumab (CDAI: 17.2% vs 9.3%, p=0.0389; SDAI: 18.4% vs 8.0%, p<0.0067; and ACR/EULAR Boolean-based remission: 18.4% vs11.1%,p=0.0569). As Felson noted, we stated that the efficacy results for adalimumab in the ADACTA trial were similar to those published previously, citing a study of adalimumab as mono-therapy conducted by van de Putte and colleagues. Aaltonen and colleagues' meta-analysis cited by Felson reports ACR50 responses for five adalimumab trials-three of which include adalimumab as combination therapy and two of which focus on adalimumab monotherapy. ACR50 responses in both monotherapy trials are comparable to those observed in the ADACTA trial. The report by Aaltonen and colleagues showed no difference in efficacy between high and usual doses of TNF inhibitors, including adalimumab. In the ADACTA trial, patients who did not have improvement of at least 20% in tender and swollen joint counts could receive an increase to weekly administration in the blinded subcutaneous medication dose by becoming part of an escape arm.