Do Biologic-treated Psoriatic Arthritis Patients with Spondylitis Respond Differently with or without Concomitant Methotrexate from Patients without Spondylitis?
Bibliographic record
Abstract
How effective is methotrexate (MTX) in psoriatic arthritis (PsA)? Should we use MTX in combination with biologic therapy in PsA? Does MTX increase therapeutic benefit when used in combination with biologics, either because of its own immunomodulatory effect or its ability to decrease immunogenicity to biologics? Or does MTX not provide additional benefit over and above the biologic agent? Instead, does it contribute only problems from a tolerability and safety perspective? Despite the fact that MTX is the most commonly used immunomodulatory drug in PsA, these questions still have not been satisfactorily answered. A variety of studies sheds light on these questions, but uncertainty remains. In this issue of The Journal , Behrens, et al study a large registry cohort in Germany to attempt to address a corollary question1. Knowing that MTX is not effective in treating the spinal symptoms of ankylosing spondylitis2, they ask the following question: In a cohort of patients with PsA, about half treated with adalimumab (ADA) monotherapy and half with concomitant MTX, if PsA subjects with spondylitis symptoms are analyzed separately from those with peripheral inflammatory musculoskeletal symptoms only, is there any difference in response to 2 years of treatment based on MTX background? There have been few placebo-controlled trials to establish the efficacy of MTX in PsA using the low-dose MTX regimen used for the treatment of rheumatoid arthritis (RA) and psoriasis. Neither Willkens, et al nor Kingsley, et al were able to demonstrate benefit of MTX over placebo as assessed by arthritis measures used at the times of those trials, although patient global assessment and some skin measures showed modest improvement3,4,5. Arguably, these were not fair trials in that the first trial studied few patients and included a low-dose arm (7.5 mg as … Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, Washington 98122, USA. E-mail: pmease{at}philipmease.com
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".