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The Efficacy and Safety of Adding Methotrexate to Etanercept in Psoriasis

A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Adding Methotrexate to Etanercept in Subjects With Moderate to Severe Plaque Psoriasis

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01001208
Enrollment
478
Registered
2009-10-26
Start date
2009-11-30
Completion date
2011-02-28
Last updated
2013-08-12

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Psoriasis

Keywords

Etanercept, Methotrexate, Psoriasis

Brief summary

The purpose of this study is to evaluate the efficacy of adding methotrexate to etanercept compared with etanercept monotherapy as measured by the percentage of participants achieving a 75% improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) at Week 24.

Interventions

DRUGMethotrexate

Methotrexate tablets over-encapsulated for blinding

DRUGEtanercept

1 mL for subcutaneous injection

DRUGPlacebo

Matching placebo to methotrexate capsules

Sponsors

Immunex Corporation
CollaboratorINDUSTRY
Amgen
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Is capable of understanding and giving written, voluntary informed consent before study screening * Male or female ≥18 years of age at time of screening * Has had stable moderate to severe plaque psoriasis for at least 6 months (eg, no morphology changes or significant flares of disease activity) * Has involved body surface area (BSA) ≥ 10% and Psoriasis Area and Severity Index (PASI) ≥ 10 at screening and at baseline * Is a candidate for systemic therapy or phototherapy in the opinion of the investigator * Has a negative test for hepatitis B surface antigen and hepatitis C antibody * Has a negative purified protein derivative test within 30 days prior to the first IP dose. Tuberculin skin tests should be considered positive when they have greater than or equal to 5 mm of induration at 48-72 hours after test is placed. Patients with a positive tuberculin skin test (if less than or equal to 14 mm of induration) are allowed if they have a history of Bacillus Calmette-Guerin vaccination with a negative Quantiferon test in the past year, no symptoms per tuberculosis worksheet, and a negative chest X ray. * Has a negative serum pregnancy test within 28 days before initiating Investigational Product (IP) and negative urine pregnancy test at baseline for females (except those at least 3 years post menopausal or surgically sterile) * Females are willing to use highly effective form of birth control (decided upon with the investigator) during the study and for 3 months after the end of treatment (except women at least 3 years post menopausal or surgically sterile) * Males are willing to use highly effective form of birth control (decided upon with the investigator) during the study and for 5 months after the end of treatment (except for men who are surgically sterile or whose female partners are at least 3 years post menopausal, surgically sterile, or are using a highly effective form of birth control) * Men with a pregnant female partner are willing to use effective methods (decided upon with the investigator) to ensure that an unborn child is not exposed to IP via semen * Patient or designee must have the ability to inject etanercept subcutaneously

Exclusion criteria

Skin-disease related * Has active guttate, erythrodermic, or pustular psoriasis at the time of the screening visit. * Has evidence of skin conditions at the time of the screening visit (eg, eczema) that would interfere with evaluations of the effect of IP on psoriasis. Medical conditions * Has significant concurrent medical conditions, including: * Type 1 diabetes * Poorly controlled type 2 diabetes (hemoglobin A1c \> 8.5) * Symptomatic heart failure (New York Heart Association \[NYHA\] class II, III, or IV) * Myocardial infarction within the last year * Current or history of unstable angina pectoris within the last year * Uncontrolled hypertension as defined by a resting blood pressure ≥ 160/95 mmHg prior to randomization (confirmed by a repeat assessment) * Severe chronic pulmonary disease (eg, requiring oxygen therapy) * No major chronic inflammatory disease or connective tissue disease other than psoriasis and/or psoriatic arthritis * Multiple sclerosis or any other demyelinating disease * Active malignancy, including evidence of cutaneous basal or squamous cell carcinoma or melanoma, or history of cancer (other than fully resected and surgically cured cutaneous basal cell and squamous cell carcinoma) within 5 years before the first IP dose. If malignancy occurred more than 5 years ago, documentation of disease-free state since treatment is required. * Known immunodeficiency syndromes including human immunodeficiency virus (HIV) * Uncontrolled, clinically significant history of renal disease * Alcoholic hepatitis * Any condition that, in the opinion of the investigator, might cause this study to be detrimental to the patient * Has any active CTC grade 2 or higher infection (including chronic or localized infections) within 30 days prior to screening, at screening, or during screening period prior to first investigational product (IP) dose * Is pregnant or breast feeding * Has any condition that could, in the opinion of the investigator, compromise the patient's ability to give written consent and/or comply with the study procedures, such as a history of substance abuse or a psychiatric condition Methotrexate contraindications or precautions * Has a family history of heritable liver disease (eg, hemachromatosis, Wilson's disease) * Has a history of or evidence at screening or baseline of alcohol abuse, alcoholic liver disease, or other clinically significant liver disease * Is unwilling or unable to limit alcohol consumption during the 24-week trial period (allowable limits are: not more than 4 drinks a week, not more than 2 drinks in a single day. 1 drink = 1 (5 oz) glass of wine = 1.5 oz liquor = 12 oz of beer or hard cider) * Has an estimated total cumulative methotrexate exposure (by medical history) exceeding 1000 mg, unless a subsequent liver biopsy has demonstrated no grade IIIb or greater injury * Has a history of significant methotrexate toxicity including pneumonitis or significant cytopenias Laboratory abnormalities * Has laboratory abnormalities at screening, including: * Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) \> the upper limit of normal (if screen fail for abnormal AST/ALT, 1 repeat measurement is allowed) * Serum total bilirubin ≥ 1.5 mg/dL * Abnormal serum albumin (\< 3.5 g/dL) * Hemoglobin \< 11 g/dL * Platelet count \< 125,000 /mm\^3 * White blood cell count \< 3,500 cells/mm\^3 * Absolute neutrophil count \< 1500/mm\^3 * Estimated creatinine clearance \< 50 mL/min (Cockroft-Gault formula, calculated value to be provided to sites) * Any other laboratory abnormality, which, in the opinion of the investigator, will prevent the patient from completing the study or will interfere with the interpretation of the study results Washouts and disallowed medications * Has used any of the following therapies within 14 days of IP initiation: * Ultraviolet light B therapy * Topical cyclosporine or calcineurin inhibitors * Topical vitamin A or D analog preparations * Class III through VII topical steroids (exception: permitted on the scalp, axillae, and groin) * Has used any of the following therapies within 28 days of IP initiation: * Intravenous or oral calcineurin inhibitors * Ultraviolet light A therapy * Psoralen and ultraviolet light A therapy * Oral retinoids * Class I or II topical steroids * Anthralin * Any other systemic psoriasis therapy (eg, cyclosporine), including oral or parenteral corticosteroids * Cyclophosphamide * Sulfasalazine * Has used methotrexate within 28 days of IP initiation. Patients with prior use of methotrexate must be excluded if subject discontinued because of a clinically significant adverse event (eg, severe skin reactions, methotrexate-induced lung disease, or any other adverse event that the investigator feels might cause this study to be detrimental to the patient) * Has used biologic therapies (other than interleukin (IL)12/IL23 inhibitors or anti-timor necrosis factor (TNF) agents) within 3 months of IP initiation * Has used an IL12/23 inhibitor within 6 months of IP initiation (eg, CNTO 1275, ABT 874) * Has used one or more anti-TNF agents (eg, etanercept, adalimumab, infliximab) within 3 months of IP initiation. Patients with prior use of an anti-TNF agent must be excluded if the subject discontinued for lack of efficacy or a clinically significant adverse event (eg, serious infection, neurologic event, malignancy, hematologic event, or any other adverse event that the investigator feels might cause this study to be detrimental to the patient). * Has previously used efalizumab (Raptiva®). * Other investigational procedures are excluded. * currently enrolled in or has not yet completed at least 30 days or 5 half-lives (if applicable; whichever is longer) since ending other investigational device or drug study(s), or is receiving other investigational agent(s).

Design outcomes

Primary

MeasureTime frameDescription
PASI 75 Response at Week 24Baseline and 24 WeeksPercentage of participants achieving at least a 75% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 24. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Secondary

MeasureTime frameDescription
Static Physician Global Assessment (sPGA) Response at Week 24Week 24Percentage of participants achieving a clear (0) or almost clear (1) status on the Static Physician Global Assessment (sPGA) at Week 24. This index evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The assessment was scored by a blinded assessor on a scale of 0 to 5, where 0 = clear, with no evidence of plaque elevation, erythema, or scale, and 5 = severe induration, erythema, and scaling.
PASI 50 Response at Week 12Baseline and 12 WeeksPercentage of participants achieving at least a 50% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 12. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.
PASI 75 Response at Week 12Baseline and 12 WeeksPercentage of participants achieving at least a 75% decrease (i.e. improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 12. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.
Static Physician Global Assessment (sPGA) Response at Week 12Week 12Percentage of participants achieving a clear (0) or almost clear (1) status on the Static Physician Global Assessment (sPGA) at Week 12. This index evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The assessment was scored by a blinded assessor on a scale of 0 to 5, where 0 = clear, with no evidence of plaque elevation, erythema, or scale, and 5 = severe induration, erythema, and scaling.
PASI 50 Response at Week 24Baseline and 24 WeeksPercentage of participants achieving at least a 50% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 24. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.
PASI 90 Response at Week 24Baseline and 24 WeeksPercentage of participants achieving at least a 90% decrese (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 24. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.
Change From Baseline in the Percentage of Body Surface Area Involved With Psoriasis at Week 12Baseline and 12 WeeksA measurement of psoriasis involvement, given as the physician's assessment of the percentage of the participant's total body surface area (BSA) involved with psoriasis. The BSA numerical score was completed by a blinded assessor. A decrease from Baseline indicates improvement. Change from Baseline was calculated as Baseline score - Week 12 score; a positive change from Baseline therefore indicates improvement.
Change Form Baseline in Percentage of Body Surface Area Involved With Psoriasis at Week 24Baseline and 24 WeeksA measurement of psoriasis involvement, given as the physician's assessment of the percentage of the participant's total body surface area (BSA) involved with psoriasis. The BSA numerical score was completed by a blinded assessor. A decrease from Baseline indicates improvement. Change from Baseline was calculated as Baseline score - Week 24 score; a positive change from Baseline therefore indicates improvement.
PASI 90 Response at Week 12Baseline and 12 WeeksPercentage of participants achieving at least a 90% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 12. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Participant flow

Recruitment details

Participants were enrolled from 09 November 2009 through 25 June 2010

Participants by arm

ArmCount
Etanercept + Methotrexate
Participants received 50 mg etanercept twice weekly (BIW) for the first 12 weeks and then 50 mg etanercept once weekly (QW) for the second 12 weeks. Participants also received active methotrexate titrated as follows: 7.5 mg per week (3 capsules) for weeks 1 and 2, 10 mg per week (4 capsules) for weeks 3 and 4, and then up to 15 mg per week (6 capsules) or the maximum tolerated dose for the remainder of the 24-week treatment period.
239
Etanercept + Placebo
Participants received 50 mg etanercept twice weekly (BIW) for the first 12 weeks and then 50 mg etanercept once weekly (QW) for the second 12 weeks. Participants also received oral placebo that was the same number of capsules per week as the methotrexate dosing regimen.
239
Total478

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event105
Overall StudyDisease Progression03
Overall StudyIneligibility Determined42
Overall StudyLost to Follow-up59
Overall StudyNoncompliance47
Overall StudyOther02
Overall StudyPhysician Decision10
Overall StudyWithdrawal by Subject45

Baseline characteristics

CharacteristicTotalEtanercept + PlaceboEtanercept + Methotrexate
Age Continuous44.11 years
STANDARD_DEVIATION 12.96
45.23 years
STANDARD_DEVIATION 12.79
42.99 years
STANDARD_DEVIATION 13.06
Body Mass Index Group
<=35 kg/m^2
345 participants173 participants172 participants
Body Mass Index Group
>35 kg/m^2
133 participants66 participants67 participants
Percent of Body Surface Area (BSA) Involved in Psoriasis24.33 Percentage of BSA
STANDARD_DEVIATION 14.82
24.23 Percentage of BSA
STANDARD_DEVIATION 13.64
24.43 Percentage of BSA
STANDARD_DEVIATION 15.94
Prior Anti-tumor Necrosis Factor (TNF) Exposure
No
388 participants191 participants197 participants
Prior Anti-tumor Necrosis Factor (TNF) Exposure
Yes
90 participants48 participants42 participants
Psoriasis Area and Severity Index (PASI) Score18.29 Units on a scale
STANDARD_DEVIATION 7.42
18.34 Units on a scale
STANDARD_DEVIATION 6.62
18.24 Units on a scale
STANDARD_DEVIATION 8.15
Race/Ethnicity, Customized
Aborigine
0 participants0 participants0 participants
Race/Ethnicity, Customized
American Indian or Alaska Native
1 participants0 participants1 participants
Race/Ethnicity, Customized
Asian
19 participants9 participants10 participants
Race/Ethnicity, Customized
Black or African American
14 participants10 participants4 participants
Race/Ethnicity, Customized
Hispanic or Latino
81 participants39 participants42 participants
Race/Ethnicity, Customized
Japanese
0 participants0 participants0 participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
3 participants1 participants2 participants
Race/Ethnicity, Customized
Other
4 participants3 participants1 participants
Race/Ethnicity, Customized
White
356 participants177 participants179 participants
Sex: Female, Male
Female
158 Participants72 Participants86 Participants
Sex: Female, Male
Male
320 Participants167 Participants153 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
58 / 23967 / 239
serious
Total, serious adverse events
3 / 2392 / 239

Outcome results

Primary

PASI 75 Response at Week 24

Percentage of participants achieving at least a 75% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 24. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Time frame: Baseline and 24 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexatePASI 75 Response at Week 2477.3 Percentage of participants
Etanercept + PlaceboPASI 75 Response at Week 2460.3 Percentage of participants
p-value: <0.0001Cochran-Mantel-Haenszel
Secondary

Change Form Baseline in Percentage of Body Surface Area Involved With Psoriasis at Week 24

A measurement of psoriasis involvement, given as the physician's assessment of the percentage of the participant's total body surface area (BSA) involved with psoriasis. The BSA numerical score was completed by a blinded assessor. A decrease from Baseline indicates improvement. Change from Baseline was calculated as Baseline score - Week 24 score; a positive change from Baseline therefore indicates improvement.

Time frame: Baseline and 24 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (MEAN)Dispersion
Etanercept + MethotrexateChange Form Baseline in Percentage of Body Surface Area Involved With Psoriasis at Week 2419.5 Percentage of BSAStandard Deviation 15.2
Etanercept + PlaceboChange Form Baseline in Percentage of Body Surface Area Involved With Psoriasis at Week 2417.8 Percentage of BSAStandard Deviation 14
p-value: 0.19952-sided van Elteren test
Secondary

Change From Baseline in the Percentage of Body Surface Area Involved With Psoriasis at Week 12

A measurement of psoriasis involvement, given as the physician's assessment of the percentage of the participant's total body surface area (BSA) involved with psoriasis. The BSA numerical score was completed by a blinded assessor. A decrease from Baseline indicates improvement. Change from Baseline was calculated as Baseline score - Week 12 score; a positive change from Baseline therefore indicates improvement.

Time frame: Baseline and 12 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (MEAN)Dispersion
Etanercept + MethotrexateChange From Baseline in the Percentage of Body Surface Area Involved With Psoriasis at Week 1216.3 Percentage of BSAStandard Deviation 13.7
Etanercept + PlaceboChange From Baseline in the Percentage of Body Surface Area Involved With Psoriasis at Week 1215.2 Percentage of BSAStandard Deviation 13.4
p-value: 0.19952-sided van Elteren test
Secondary

PASI 50 Response at Week 12

Percentage of participants achieving at least a 50% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 12. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Time frame: Baseline and 12 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexatePASI 50 Response at Week 1292.4 Percentage of participants
Etanercept + PlaceboPASI 50 Response at Week 1283.8 Percentage of participants
p-value: 0.0112Cochran-Mantel-Haenszel
Secondary

PASI 50 Response at Week 24

Percentage of participants achieving at least a 50% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 24. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Time frame: Baseline and 24 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexatePASI 50 Response at Week 2491.6 Percentage of participants
Etanercept + PlaceboPASI 50 Response at Week 2484.6 Percentage of participants
p-value: 0.0112Cochran-Mantel-Haenszel
Secondary

PASI 75 Response at Week 12

Percentage of participants achieving at least a 75% decrease (i.e. improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 12. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Time frame: Baseline and 12 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used

ArmMeasureValue (NUMBER)
Etanercept + MethotrexatePASI 75 Response at Week 1270.2 Percentage of participants
Etanercept + PlaceboPASI 75 Response at Week 1254.3 Percentage of participants
p-value: 0.0112Cochran-Mantel-Haenszel
Secondary

PASI 90 Response at Week 12

Percentage of participants achieving at least a 90% decrease (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 12. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Time frame: Baseline and 12 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexatePASI 90 Response at Week 1234 Percentage of participants
Etanercept + PlaceboPASI 90 Response at Week 1223.1 Percentage of participants
p-value: 0.0348Cochran-Mantel-Haenszel
Secondary

PASI 90 Response at Week 24

Percentage of participants achieving at least a 90% decrese (improvement) from Baseline in the Psoriasis Area and Severity Index (PASI) at Week 24. PASI Score incorporates measures of erythema, desquamation, infiltration, and affected body surface area. Involvement and severity of psoriasis was scored by a blinded assessor using a scale of 0 to 72, where 0 = no psoriasis and 72 = severe disease.

Time frame: Baseline and 24 Weeks

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexatePASI 90 Response at Week 2453.8 Percentage of participants
Etanercept + PlaceboPASI 90 Response at Week 2434.2 Percentage of participants
p-value: 0.0112Cochran-Mantel-Haenszel
Secondary

Static Physician Global Assessment (sPGA) Response at Week 12

Percentage of participants achieving a clear (0) or almost clear (1) status on the Static Physician Global Assessment (sPGA) at Week 12. This index evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The assessment was scored by a blinded assessor on a scale of 0 to 5, where 0 = clear, with no evidence of plaque elevation, erythema, or scale, and 5 = severe induration, erythema, and scaling.

Time frame: Week 12

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexateStatic Physician Global Assessment (sPGA) Response at Week 1265.5 Percentage of participants
Etanercept + PlaceboStatic Physician Global Assessment (sPGA) Response at Week 1247 Percentage of participants
p-value: 0.0112Cochran-Mantel-Haenszel
Secondary

Static Physician Global Assessment (sPGA) Response at Week 24

Percentage of participants achieving a clear (0) or almost clear (1) status on the Static Physician Global Assessment (sPGA) at Week 24. This index evaluates the physician's global assessment of the participant's psoriasis based on severity of induration, scaling, and erythema. The assessment was scored by a blinded assessor on a scale of 0 to 5, where 0 = clear, with no evidence of plaque elevation, erythema, or scale, and 5 = severe induration, erythema, and scaling.

Time frame: Week 24

Population: Intention-to-Treat with available data; last observation carried forward (LOCF) imputation was used.

ArmMeasureValue (NUMBER)
Etanercept + MethotrexateStatic Physician Global Assessment (sPGA) Response at Week 2471.8 Percentage of participants
Etanercept + PlaceboStatic Physician Global Assessment (sPGA) Response at Week 2454.3 Percentage of participants
p-value: 0.0112Cochran-Mantel-Haenszel

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026