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. 2009 Jun;68(6):914-21. Epub 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,

Güler-Yüksel M, Zwinderman AH, Kerstens PJ, van der Lubbe PA, de Beus

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

Allaart CF.

Leiden University Medical Center, The Netherlands.

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

functional ability and radiological damage after 4 years of

response-driven treatment according to four different treatment

strategies for rheumatoid arthritis (RA).

METHODS: Patients with recent-onset, active RA (n = 508) were randomly

assigned to four 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 3-monthly disease activity

score (DAS) assessments, aiming at a DAS < or =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. The 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 four 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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