Background/Purpose: It remains to be determined if setting remission or low disease activity as treatment target affects significant outcomes in early active rheumatoid arthritis (RA) patients. We compared 2 patient groups who were treated for 5 years aiming at DAS<1.6 or DAS≤2.4.

Methods: Five years outcomes were compared in 133 patients from the BeSt study (inclusion criteria: early (≤2 years symptom duration) active (≥6 of 66 swollen joints, ≥6 of 68 tender joints, and either erythrocyte sedimentation rate ≥28 mm/hour or a visual analogue scale global health score ≥20mm) RA (1987)), randomized to initial therapy with methotrexate, sulfasalazine and tapered high dose of prednisone (arm 3), targeted at DAS≤2.4 (‘LDA target group’), and 175 early RA patients from the IMPROVED-study who would have fulfilled the inclusion criteria of the BeSt-study, who started with methotrexate and tapered high dose of prednisone, targeted at DAS<1.6 (‘remission target group’). To correct for baseline differences, the associations of treatment target with achieving DAS<1.6, Boolean remission at year 1 and drug-free DAS-remission (DFR) at year 5 were analysed by logistic regression analysis.

Results: At baseline, patients in the remission target group had earlier and less active disease than the LDA target group (mean DAS±SD 4.1±0.7 vs 4.4±0.9, p=0.012) (table), and they had better outcomes at the first evaluation point (after 4 months of treatment and 3 months in the LDA target group). The DAS target was achieved by 56% (LDA target group) and 53% (remission target group) (table). At year 1, the DAS target was achieved by 67% (DAS≤2.4) and 51% (DAS<1.6). Similar percentages in both groups had a DAS≤2.4 (67% (DAS≤2.4) and 73% (DAS<1.6), p=0.333), but DAS<1.6 was achieved more often in the remission targeted group (51% (DAS<1.6) vs 30% (DAS≤2.4), p<0.001). DFR was by protocol not possible at year 1 in the LDA targeted group. 15% of the remission target group were in DFR. There was less radiological damage progression in the remission target group (median (IQR)/mean±SD 0 (0-0)/0±0.2 (DAS<1.6) vs 0 (0-1)/0.9±2.3 (DAS≤2.4), p<0.001). At year 5, the target was achieved in 43% (remission target group) and 61% (LDA target group). DAS≤2.4 was achieved in similar percentages (61% vs 61%, p=0.092). More patients in the remission targeted group had DAS<1.6 and DFR (43% vs 32%, p=0.003, and 18% vs 8%, p=0.003, respectively).

DAS<1.6 as treatment target was associated with more DAS<1.6 (OR 3.04 (95% CI 1.64-5.62)) and Boolean remission (3.03 (1.45-6.33)) at year 1 and more DFR at year 5 (3.77 (1.51-9.43)) corrected for gender, symptom duration, baseline DAS, baseline SHS, and time on anti-TNF.

Conclusion: Early active RA patients had better outcomes after DAS<1.6 than DAS≤2.4 steered treatment. DAS-remission targeted treatment was an independent predictor for achieving DAS<1.6 and Boolean remission at year 1 and DFR at year 5.