Background/Purpose: Achievement of clinical remission not only early in disease course but also early in treatment course may be critical for functional outcome of patients with rheumatoid arthritis (RA). Patients showing clinical response to certolizumab at week 6 demonstrated greater ACR responses, higher rates of remission, and improved patient-reported outcomes after 1 year compared to patients who had a response at week 12. Response to treatment as early as week 6 predicted continuation of treatment with TNFα blockers in long-term follow-up. Objective of study was to establish rate of patients on etanercept (ETA) achieving clinical remission at week 4 (fast) or week 12 of treatment (slow remission responders). To determine effects of fast versus slow remission response on clinical and radiographic remission. To identify predictors for fast remission response.

Methods: Retrospective case control study was performed on RA patients who started ETA from 2004 to 2010 due to moderate-severe disease activity despite DMARDs. Patients having available control at first and third month were enrolled. Patients achieving DAS28 remission by first month were defined as fast remission responders. Patients reaching DAS28 remission at three month as slow remission responders. Patients not reaching remission within 3 months or not maintaining remission for at least one year were excluded because considered unresponsive. Fast remission responders were compared with slow responders regarding maintenance of clinical remission on ETA in longterm follow-up. Arrest of radiolgraphic progression was determined by Total Sharp Score modified van der Heijde (TSS) on X-rays performed at baseline and after 1 year. Clinical and therapeutic baseline characteristics were compared between fast and slow remission responders. Statistical analysis was performed by Student T-test and Pearson test as appropriate. Multivariate logistic regression was applied to find predictors for fast remission response.

Results: 74 of total 186 RA patients identified reached DAS28 remission within the first treatment month with ETA and were classified as fast remission responders (39.7%). Only 8 of 74 fast remission responders (10.8%) lost disease control by ETA in follow-up (mean 3.5 years) compared with 25% of slow remission responders (28 out of 112, p < 0.05). Considering patients with early RA (disease duration ≤ 1 year) difference was even more significant (14.3 vs 64.7%, p <0.05). Radiographic progression (ΔTSS>1) occurred in 5.8% of fast but 16.3% of slow remission responders (p < 0.05). No difference was found for analyzed patients’ baseline characteristics or past and concomitant therapy. None of the baseline characteristics was predictive for fast remission response.

Conclusion: Fast remission response to ETA at week 4 was achieved in 39.7% of RA patients with early and established disease, and determined better outcome by greater maintenance of clinical and radiographic remission compared to slow remission responders at week 12. Fast remission response resulted to be an independent factor for outcome as it could not be predicted by other parameters but only clinically assessed by tight control.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fast-remission-response-to-etanercept-at-week-4-predicts-better-long-term-outcomes-in-early-and-established-rheumatoid-arthritis-compared-to-slower-response-at-week-12/