RESEARCH - Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent onset RA

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Ann Rheum Dis. 2008 Jul 28.

Drug-free remission, functioning and radiographic damage after 4 years

of response-driven treatment in patients with recent onset rheumatoid

arthritis.

Van Der Kooij SM, Goekoop-Ruiterman YP, De Vries-Bouwstra JK,

Guler-Yuksel M, Zwinderman AH, Kerstens PJ, Van Der Lubbe PA, De Beus

WM, Grillet BA, Ronday K, Huizinga TW, Breedveld FC, Dijkmans BA,

Allaart CF.

LUMC, Netherlands.

OBJECTIVES: To compare the occurrence of drug-free remission,

functional ability and radiological damage after 4 years of

response-driven treatment according to 4 different treatment

strategies for rheumatoid arthritis (RA). METHODS: Patients with

recent onset, active RA (n=508) were randomized to 4 different

treatment strategies: (1) sequential monotherapy; (2) step-up

combination therapy; (3) initial combination therapy with prednisone;

and (4) initial combination therapy with infliximab. Treatment was

adjusted based on three-monthly disease activity score (DAS)

assessments, aiming at a DAS </=2.4. From the third year, patients

with a sustained DAS <1.6 discontinued treatment. RESULTS: In total,

43% of patients were in remission (DAS <1.6) at 4 years, and 13% were

in drug-free remission: 14, 12, 8 and 18% of patients in groups 1-4,

respectively. Absence of anti-cyclic citrullinated peptide antibodies,

male gender and short symptom duration were independently associated

with drug-free remission. Functional ability and remission were

maintained in all 4 groups with the continuation of DAS-driven

treatment, without significant differences between the groups.

Significant progression of joint damage was observed in 38% and 31% of

patients in groups 3 and 4 versus 51% and 54% of patients in groups 1

and 2 (P<0.05, group 4 versus groups 1 and 2, group 3 versus group 2).

CONCLUSIONS: In patients with recent onset active RA, drug-free

remission was achieved in up to 18% of patients. DAS-driven treatment

maintained clinical and functional improvement, independent of the

treatment strategy. Joint damage progression remained significantly

lower after initial combination therapy compared with initial

monotherapy.

PMID: 18662933

http://www.ncbi.nlm.nih.gov/pubmed/18662933

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