Background/Purpose: Treat-to-target (T2T) in early Rheumatoid Arthritis (RA) has been successfully implemented in daily clinical practice. Patients achieve remission very early and during a follow-up of three years T2T leads to persistent low disease activity in most patients and high remission rates. Unfortunately, some patients do not respond to this approach and remain in – or return to – moderate or high disease activity. These patients should be recognized early, as they might benefit from alternative therapeutic approaches. The aim of this study is to describe the five year clinical outcome of implementation of a T2T strategy in early RA. We aim to identify subgroups of patients with distinct long-term trajectories of disease activity.

Methods: In DREAM remission induction cohort I, patients with newly diagnosed RA were treated according to a T2T step-up strategy aiming at remission. Treatment consisted of methotrexate, followed by the addition of sulfasalazine and subsequently exchange of sulfasalazine with a tumor necrosis factor inhibitor in case of persistent disease activity. The mean change in the disease activity score in 28 joints (DAS28) was analysed with a linear mixed model. Subgroups of patients with distinct trajectories of disease activity were described and predictors will be identified.

Results: Data of 229 patients were used (63% female, mean age 57 years, 78% fulfilling the ACR 1987 criteria). Remission rates at 12 weeks, 24 weeks, 1 year, 3 years and 5 years were 31.1%, 48.8%, 60.6%, 63.6% and 63.2%, respectively. Mean DAS28 improved from 4.93 (95% CI 4.79 – 5.07) at baseline to 2.44 (95% CI 2.28 – 2.60) after five years (p<0,0001). Four subgroups with distinct trajectories of disease activity could be identified. A very small group (2.2%) could be classified as non-responders: they did not achieve remission at any moment during the first five year of follow-up. The second group (21.4%), the poor-responders, reached remission only after the first year. The third and largest group (68.1%), the responders, achieved remission within the first year and then had a varied course of disease activity. Finally, the fourth group with the best outcome (8.3%) achieved remission in the first year and remained in remission during the whole follow-up. Analysis of predictors will follow.

Conclusion: Implementation of a treat-to-target per-protocol treatment strategy leads to high long-term remission rates in daily clinical practice. Four groups with distinct trajectories of disease activity could be described. Predictors will be identified and presented during the 2015 ACR annual meeting.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-high-remission-rates-and-distinct-trajectories-of-disease-activity-following-the-implementation-of-treat-to-target-in-early-rheumatoid-arthritis/