An evidence-based review of certolizumab pegol in the treatment of active psoriatic arthritis: place in therapy

Figures & data

Figure 1 Antibody structure. Each chain is divided into regions or domains.

Notes: The light chain has two domains and the heavy chain has four domains. The Fab region is responsible for the unique specificity of antibody molecules to antigen. The Fc region is not antigen specific, but is necessary for other antibody functions such as complement fixation and cell lysis.
Abbreviations: Fab, fragment antigen-binding; Fc, fragment crystallizable.

Figure 2 Certolizumab pegol.

Notes: Humanized Fab fragment. Certolizumab pegol is a polyethylene glycosylated Fab’ fragment of humanized (95% human IgG 1 isotype) anti-TNF-α monoclonal antibody.
Abbreviations: C, constant region; CD, complimentary domain; CH, constant heavy chain region; PEG, polyethylene glycol; TNF, tumor necrosis factor; V, variable region; Fab, fragment antigen-binding.

Table 1 Efficacy of CZP in patients with psoriatic arthritis (RAPID-PsA trial)

Outcome	CZP 200 Q2W n=138 (%)		CZP 400 Q4W n=135 (%)		Placebo n=136 (%)
	Week
	12	24	12	24	12	24
ACR20 (%)	58	63.8	52	56.3	24	23.5
ACR50 (%)	36	44.2	32.6	40	11	12.5
ACR70 (%)	24.6	28.3	12.6	23.7	2.9	4.4
PASI 50 (%)	68.9	n/a	63.2	n/a	26.7	n/a
PASI 75 (%)	46.7	62.2	47.4	60.5	14	15.1
PASI 90 (%)	22.2	n/a	19.7	n/a	4.7	n/a
PsARC (%) Concomitant	73.7 (73/99)	n/a	63.0 (63/100)	n/a	42.0 (37/88)	n/a
DMARD at baseline
PsARC (%) No concomitant	71.8 (28/39)	n/a	74.3 (26/35)	n/a	31.3 (15/48)	n/a
DMARD at baseline
MDA (%)	n/a	33.3	n/a	34.1	n/a	5.9
HAQ-DI (mean change from baseline ± SD)	n/a	−0.52±0.66	n/a	−0.43±0.54	n/a	−0.17±0.43
Leeds Enthesitis Index, n	n/a	91	n/a	88	n/a	84
Mean change from baseline ± SD		−1.1±1.8		−2.0±1.8*		−1.8±1.9**
Leeds Dactylitis Index, n	n/a	35	n/a	35	n/a	38
Mean change from baseline ± SD		−22.0±46.9		−40.7±34.6**		−53.5±69.1*

Notes:

* P<0.001;

** P<0.003. Data from Mease et al.²⁷

Abbreviations: ACR, American College of Rheumatology; CZP, certolizumab pegol; DMARD, disease-modifying antirheumatic drug; HAQ-DI, Health Assessment Questionnaire-Disability Index; MDA, minimal disease activity; n/a, not available; PASI, Psoriasis Area and Severity Index; PsARC, psoriatic arthritis response criteria; Q2W, every 2 weeks; Q4W, every 4 weeks; SD, standard deviation.

MeasePJFleischmannRDeodharAAEffect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a Phase 3 double-blind randomised placebo-controlled study (RAPID-PsA)Ann Rheum Dis2014731485523942868

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