RESEARCH - New treatment strategy for RA leaves 50 percent of recent onset patients symptom-free within 36 weeks

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New Treatment For Rheumatoid Arthritis Leaves 50 Percent Of Recent

Onset Patients Symptom-free Within 36 Weeks

ScienceDaily (June 16, 2008) — At least 50% of recent onset rheumatoid

arthritis patients achieve remission (a state free of signs and

symptoms) within 36 weeks when following a systematic approach of

step-up DMARD treatment in combination with tight control, according

to results of a study presented June 11 at EULAR 2008, the Annual

Congress of the European League Against Rheumatism in Paris, France.

Results of this study indicate that achieving remission is not only

possible during clinical trials but can be a realistic goal of

standard clinical care.

Of 169 early RA patients, remission (defined as DAS28<2.6) was

achieved in 15.5% at week 8 (23/148), 22.2% at week 12 (24/108), 30.7%

at week 20 (23/75), 38.8% at week 24 (33/85), 52.1% at week 36 (38/73)

and 51% at week 48-52 (26/51).

The researchers achieved these results through implementation of a

tightly regulated DMARD treatment scheme, as follows:

Methotrexate 15mg/week was initiated following diagnosis

If remission was not achieved at week 8, the dose was increased to 25mg/week

If not achieved at week 12, sulfasalazine was added (2grams/day)

If not achieved at week 20, the dose was increased to 3grams/day

If not achieved at week 24 adalimumab was added to methotrexate

Every 3 months thereafter, therapy could be adjusted based on DAS28,

also using other TNF-blockers. Patients were allowed to take NSAIDs,

and prednisolone d10mg/day and intra-articular corticosteroid

injections could be administered

Dr. H. Kuper and Prof M. van de Laar of Medisch Spectrum Twente &

University Twente, the Netherlands, who led the study, said; " In many

large clinical trials, remission can be considered a realistic goal.

We set out to determine whether all patients presenting in daily

clinical practice can reasonably expect to achieve a state free of

signs and symptoms, if a strict treatment schedule was followed. Our

results show that remission is indeed achievable in as many as half of

clinical practice patients following this schedule, which could

indicate that remission is a realistic treatment goal of daily

clinical practice. "

As part of the Dutch Rheumatoid Arthritis Monitoring Registry (DREAM),

investigators performed a prospective descriptive study of a cohort of

recent onset rheumatoid arthritis DMARD-naïve, patients in daily

clinical practice, between January 2006 and January 2008. 190

consecutive patients with recently diagnosed RA under the care of the

rheumatology clinics of three hospitals in the Netherlands were

included. Results were taken from the first 169 patients with

DAS28>3.2 at inclusion.

At baseline, patient characteristics between the hospitals were

comparable -- average patient age was 57.3 years (13.7), 63.9% were

female, 52.7% of which were rheumatoid factor positive, with an

average disease duration of 16 weeks (1-52), ESR 33.2 (20.5), CRP 23.5

(26.4), DAS28 5.1 (1.1), HAQ 1.3 (0.6).

http://www.sciencedaily.com/releases/2008/06/080611135043.htm

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Not an MD