ACR ABSTRACT - Long-term remission in daily clinical practice: DREAM

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[662] - Long-Term Remission in Daily Clinical Practice: Excellent 2

Year Results with Treatment To Target in Very Early Rheumatoid

Arthritis, Results of the DREAM Remission Induction Cohort.

Marloes Vermeer1,Ina H. Kuper1, Hoekstra2,Hein J. Bernelot

Moens3,Marcel D. Posthumus4,Herman L.M. Brus5,Piet L.C.M. van

Riel6,Mart A.F.J. van de Laar1. 1University of Twente and Medisch

Spectrum Twente, Enschede, The Netherlands,2Isala Klinieken, Zwolle,

The Netherlands,3Ziekenhuisgroep Twente, Almelo/Hengelo, The

Netherlands,4University Medical Center Groningen, Groningen, The

Netherlands,5TweeSteden Ziekenhuis, Tilburg, The Netherlands,6Radboud

University Nijmegen Medical Centre, Nijmegen, The Netherlands

Background: Remission is the primary target of treatment of rheumatoid

arthritis (RA). Clinical trials have proven that systematic monitoring

of disease activity and adjusting medication on the basis of the

disease activity outcome is effective in reaching this goal.

Therefore, in current guidelines and recommendations on RA it has been

advocated to treat RA to target. However, aiming for remission is not

yet implemented and data on inducing and achieving remission in daily

clinical practice are limited. The objective of this study was to

evaluate disease activity in very early RA patients in daily clinical

practice after 2 years of applying a tight control treatment strategy.

Methods: Since January 2006, 534 newly diagnosed patients with early

RA (clinical diagnosis of RA, symptom duration ≤ 1 year) were enrolled

in the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission

induction cohort study. Treatment adjustments (4-8 weekly) were based

on the DAS28, aiming at DAS28 < 2.6. The medication protocol consisted

of initial MTX, addition of SSZ, exchange of SSZ by anti-TNF in case

of insufficient response. Primary outcome was the disease activity

according to the DAS28, EULAR response criteria and ACR criteria for

clinical remission after 1 and 2 years. Additional outcomes included

time to first remission and sustainability of remission.

Results: Baseline characteristics were as follows: mean (SD) age 57.7

(13.9) years, 62.8% female, 56.6% RF positive, 62.4% anti-CCP

positive, median (IQR) symptom duration 15 (8-26) weeks, mean (SD)

baseline DAS28 5.0 (1.1) and 82.8% of patients fulfilled the ACR

classification criteria for RA. Of all patients, 1 year follow-up data

was available in 392 patients and 2 year data in 210 patients. At 1

year (n=392), 55.1% of patients achieved DAS28 remission, 64.8% had a

good EULAR response and 45.1% satisfied the ACR remission criteria

(Table 1). At 2 years (n=210), 64.3% of patients achieved DAS28

remission, 75.7% had a good EULAR response and 54.4% satisfied the ACR

remission criteria (Table 1). Median (IQR) time to first DAS28

remission was 22 (12-37) weeks. In more than 60% (127/210) of patients

sustained DAS28 remission (≥ 6 months) was observed during the first 2

years of follow-up. The majority of patients achieved remission on

conventional DMARDs (mono or combination therapy). Results were

independent of the definition of RA (i.e. clinical diagnosis/ACR 1987

criteria) or presence of traditional prognostic factors for RA (i.e.

RF/anti-CCP).

Conclusion: This study shows that long-term remission is a realistic

goal in very early RA patients in daily clinical practice.

Implementation of a tight control treatment strategy results in rapid

and high remission rates, regardless of the definition used. The

management of very early RA patients in clinical care can go beyond

the control of signs and symptoms, and should aim at remission.

Abstract 662

Monday, November 8, 2010, 3:30 pm

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