RESEARCH - Disease activity score-driven therapy versus routine care: GUEPARD and ESPOIR

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Ann Rheum Dis doi:10.1136/ard.2010.137695

Clinical and epidemiological research

Extended report

Disease activity score-driven therapy versus routine care in patients

with recent-onset active rheumatoid arthritis: data from the GUEPARD

trial and ESPOIR cohort

M Soubrier1, C Lukas2, J Sibilia3, B Fautrel4, F Roux5, L Gossec6, S

Patternotte6, M Dougados6

1Department of Rheumatology, Hôpital G Montpied, Clermont-Ferrand, France

2Department of Rheumatology, Hôpital Lapeyronie, Montpellier, France

3Department of Rheumatology, Hôpital Hautepierre, Strasbourg, France

4Department of Rheumatology, Hôpital la Pitié Salpétrière, Paris, France

5Department of Biostatistics, RCTs, Lyon, France

6Department of Rheumatology B, Hôpital Cochin, Paris, France

Accepted 7 November 2010

Published Online First 17 January 2011

Abstract

Objectives To compare the efficacy of disease activity score in 28

joints (DAS28ESR)-driven therapy with anti-tumour necrosis factor

(patients from the GUEPARD trial) and routine care in patients with

recent-onset rheumatoid arthritis (patients of the ESPOIR cohort).

Results After matching GUEPARD and ESPOIR patients on the basis of a

propensity score and a 1:2 ratio, at baseline all patients had

comparable demographic characteristics, rheumatoid factor, anticyclic

citrullinated peptide antibody positivity and clinical disease

activity parameters: erythrocyte sedimentation rate, C-reactive

protein, mean DAS (6.26±0.87), Sharp/van der Heijde radiographic score

(SHS), health assessment questionnaire (HAQ). Disease duration was

longer in GUEPARD patients (5.6±4.6 vs 3.5±2.0 months, p<0.001). After

1 year, the percentage of patients in remission with an HAQ (<0.5) and

an absence of radiological progression was higher in the tight control

group (32.3% vs 10.2%, p=0.011) as well as the percentage of patients

in low DAS with an HAQ (<0.5) and an absence of radiological

progression (36.1% vs 18.9%, p=0.045). However, there was no

difference in the decrease in DAS, nor in the percentage of EULAR

(good and moderate), ACR20, ACR50 and ACR70 responses. More patients

in the tight control group had an HAQ below 0.5 (70.2% vs 45.2%,

p=0.005). Overall, pain, patient and physician assessment and fatigue

decreased more in the tight control group. The mean SHS progression

was similar in the two groups as was the percentage of patients

without progression.

Conclusions In patients with recent onset active rheumatoid arthritis,

a tight control of disease activity allows more patients to achieve

remission without disability and radiographic progression.

http://ard.bmj.com/content/early/2011/01/12/ard.2010.137695.abstract?papetoc

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