Background/Purpose:

To assess differences in frequency of biological therapy use and functional ability in early RA patients two years after starting induction therapy according to three different treatment regimens.

Methods:

Data were used from patients with recent-onset arthritis participating in a single-blinded clinical trial (Treatment in the Rotterdam Early Arthritis CoHort (tREACH))(1) in which three induction therapy strategies were compared: (A1) combination therapy (methotrexate (MTX) + sulfasalazine + hydroxychloroquine) with glucocorticoids (GCs) intramuscularly; (A2) combination therapy with an oral GC tapering scheme and (B) MTX with oral GCs similar to B. As no difference in disease activity scores (DAS) was found between groups A1 and A2 at 3 and 12 months of follow-up(1), these groups were combined for this analysis (group A). Disease activity scores (original DAS) were assessed every 3 months. Functional ability was assessed using the Health assessment questionnaire (HAQ). Data were analysed using simple descriptive statistical techniques.

Results:

281 patients (91 men, 190 women; mean baseline DAS 3.3, median baseline HAQ 1.00) were initially randomized. Data on medication use at 2 years were available from 248 patients (88%), see figure 1. At 2 years, 24% of patients in group A versus 43% in group B were using a biological DMARD. Biological use and DAS over time are demonstrated in figure 2.

Equal mean DAS of 1.66 (95%CI 1.54-1.78) at 24 months was observed for the initial treatment groups at 24 months (group A: 1.58 (95%CI 1.43-1.73), group B: 1.80 (95%CI 1.58-2.02). DAS remission (DAS<1.6) was achieved by 53% of patients.

The median disability score (HAQ (min-max)) was 0.38 (0-2) for all patients but varied in the treatment groups: A. 0.25 (0-1.9) and B. 0.63 (0-2.1) (p=0.042).

Conclusion:

We observed lower use of biological therapy and better functional ability in induction triple therapy compared to induction monotherapy MTX with GC bridging at  2 years of follow-up in the treat-to-target tREACH study. No differences were found for disease activity scores.

1.    De Jong et al. Randomised comparison of initial triple DMARD therapy with methotrexate monotherapy in combination with low-dose glucocorticoid bridging therapy; 1-year data of the tREACH trial. Ann Rheum Dis. 2014 Jul;73(7):1331-9.