REVIEW - Remission in RA: wishful thinking or clinical reality?

[Guest guest]

Semin Arthritis Rheum. 2005 Dec;35(3):185-96.

Remission in rheumatoid arthritis: wishful thinking or clinical reality?

Sesin CA, Bingham CO 3rd.

Division of Rheumatology, NYU-Hospital for Joint Diseases, New York, NY,

USA.

OBJECTIVES: To review the concept of remission in rheumatoid arthritis (RA),

as defined by the Food and Drug Administration (FDA), the American College

of Rheumatology (ACR), and the European League Against Rheumatism (EULAR).

To delineate differences between significant clinical improvements, very low

disease activity, and the achievement of true remission. To evaluate the

prevalence of these outcomes with biologic therapy and traditional

disease-modifying antirheumatic drugs (DMARD) regimens. METHODS: The MEDLINE

database was searched for the key words " remission " and " rheumatoid

arthritis. " Efficacy data of RA clinical trials from 1985 to 2004 are based

on a literature review of medical journals and abstracts from rheumatology

meetings. We review 3 well-defined sets of criteria established by the ACR,

EULAR, and the FDA for measuring remission. RESULTS: Defining remissions in

clinical trials and clinical practice requires appropriate standardized and

objective outcome measures, such as the ACR and EULAR remission criteria.

Traditional DMARDs often provide symptom relief, improvements in physical

function, and the slowing of radiographic progression in patients with RA,

but rarely lead to the complete cessation of RA activity. Remission, as

defined by the ACR criteria, has been observed in 7 to 22% of patients

treated with traditional DMARD monotherapy (ie, gold, penicillamine,

methotrexate [MTX], cyclosporine A, or sulfasalazine), but these remissions

have often been short-lived. Treatments with DMARD combinations, biologic

monotherapy, and biologic combination therapy with MTX offer greater hope

and may facilitate the higher rates of remission. Clinical trial results

have shown that newer DMARDs such as leflunomide or the combination of

multiple DMARDs can generally elicit greater EULAR remission rates (ranging

from 13 to 42%) than monotherapies. Biologic combinations with MTX have also

been shown to induce significant remission (as defined by the EULAR

criteria) in RA patients, with a 31% rate observed with infliximab plus MTX

at 54 weeks, a 50% rate observed for adalimumab plus MTX after 2 years of

therapy, and a 41% rate observed for etanercept plus MTX after 2 years of

therapy.

CONCLUSIONS: In the era of biologics and combination therapy, identifying

remission or at least very low disease activity as the ultimate goal in RA

therapy should become the new standard for the outcome of all RA trials. The

criteria established by the FDA, the ACR, and the EULAR represent an

important step toward achieving this goal.

PMID: 16325659

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ct & list_uids=16325659

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

Remission is what I pray for. It has always been the focus. The meds

stop working in some cases after longterm use as did enbrel for me so

just continued medication use isn't appealing to me. I took it until

it no longer worked on any level. So remission is what I hold out hope

for. Otherwise, I am just hopping from medication to medication

looking for something that works longterm.

Interesting article.

Thanks for posting it.

Ebony