Re: RESEARCH - Discontinuing treatment in patients with RA in sustained clinical remission: BeSt

[Guest guest]

Thanks so much for posting this !

Do you think this includes MTX, or just the biologics?

Thanks, OKD

[Guest guest]

What this is telling me is that if you are in remission, it is okay to try to

discontinue drugs because if you relapse and have to go back on drugs, you can

achieve remission quickly again and would not sustain joint damage in the

process. Is that how others read this?

This is very encouraging. Dr. Keystone said he would consider tapering drugs

after 6 months of remission and this study seems to say the same. My rheum says

I am on meds for life and told me about a patient in remission who tried going

off and relapsed.....but at least that patient now knows he can't make it

without meds. If 25% can, it seems to be worth trying. I am not at that point,

but something to think about for the future.

Janice in GA

>

> Ann Rheum Dis. 2011 Feb;70(2):315-9. Epub 2010 Nov 10.

>

>

> Discontinuing treatment in patients with rheumatoid arthritis in

> sustained clinical remission: exploratory analyses from the BeSt

> study.

>

>

> Klarenbeek NB, van der Kooij SM, Güler-Yüksel M, van Groenendael JH,

> Han KH, Kerstens PJ, Huizinga TW, Dijkmans BA, Allaart CF.

> Leiden University Medical Center, Leiden, The Netherlands.

>

>

> Abstract

>

> OBJECTIVES: To determine the relapse rate after discontinuing

> treatment in patients with rheumatoid arthritis (RA) in sustained

> clinical remission, to identify predictors of a relapse and to

> evaluate treatment response after restarting treatment.

>

> METHODS: Five-year data from the BeSt study were used, in which 508

> patients with recent-onset RA were randomised into four dynamic

> treatment strategies, aiming at a disease activity score (DAS) ≤ 2.4.

> When DAS was < 1.6 for ≥ 6 months, the last disease-modifying

> antirheumatic drug (DMARD) was tapered and discontinued. If DAS

> increased to ≥ 1.6, the last DMARD was immediately reintroduced.

>

> RESULTS: During a 5-year period, 115/508 patients (23%) achieved

> drug-free remission. Of these, 53 patients (46%) restarted treatment

> because the DAS was ≥ 1.6 after a median of 5 months, 59 patients

> (51%) remained in drug-free remission for a median duration of 23

> months and 3 (3%) were lost to follow-up. In those who restarted

> treatment, mean (SD) DAS increased from 1.13 (0.73) at remission

> before tapering to 2.18 (0.65) at restart, reflecting an increase in

> all four components of DAS. Multivariable predictors for restarting

> treatment were anti-cyclic citrullinated peptide (anti-CCP), last

> DMARD sulfasalazine, low baseline Health Assessment Questionnaire

> score and high mean DAS until remission. Of the 53 patients who

> restarted treatment, 39 (74%) again achieved remission 3-6 months

> after the restart. The median (IQR) damage progression in those who

> restarted treatment during the year of DAS increase was 0 (0-1)

> Sharp-van der Heijde units.

>

> CONCLUSION: During 5 years DAS steered treatment, nearly 25% of

> patients with RA achieved drug-free remission; 46% restarted DMARD

> monotherapy because of a relapse, the majority of whom again achieved

> clinical remission within 3-6 months without showing radiological

> progression during the relapse.

>

>

> PMID: 21068104

>

> http://www.ncbi.nlm.nih.gov/pubmed/21068104

>

>

>

>

> Not an MD

>

[Guest guest]

Hi, OKD.

This is a follow-up study of the same subjects in the BeSt trial which

was begun over 5 years ago. The original research is very important

and interesting. The researchers compared four different RA treatment

strategies in 508 patients for one year.

You can read it in full here:

http://onlinelibrary.wiley.com/doi/10.1002/art.21405/full

A short summary of what they did:

**************************

The BeSt (Dutch acronym for Behandel-Strategieën, “treatment

strategies”) study is a multicenter, randomized clinical trial in

which we compared the clinical and radiographic outcomes of 4

different treatment strategies: sequential monotherapy (group 1),

step-up combination therapy (group 2), initial combination therapy

with tapered high-dose prednisone (group 3), and initial combination

therapy with the TNF antagonist infliximab (group 4). The common goal

in all strategies was to reduce disease activity rapidly and

persistently by tight monitoring and immediate adjustment of therapy

in the case of an insufficient response. Here we present the results

of the first year of followup.

**************************

Group 3 began with MTX + SSZ + prednisone and had very good results.

Some of the lessons learned from the trial: early aggressive treatment

is better than delayed aggressive therapy, combination therapy from

the start is better than sequential monotherapy or trying a

combination later, tight control of the disease, which is accomplished

by measuring the disease activity score (DAS) and adjusting the

medications as necessary to keep it low, is extremely important.

Not an MD

On Tue, Mar 15, 2011 at 8:32 AM, OKD <Cofade_2000@...> wrote:

> Thanks so much for posting this !

>

> Do you think this includes MTX, or just the biologics?

>

> Thanks, OKD