Session Type: ACR Concurrent Abstract Session
Session Time: 11:00AM-12:30PM
Background/Purpose: To assess clinical and radiological outcomes of induction therapy followed by 5 years disease activity score (DAS)-remission steered treatment in early arthritis patients.
Methods: The IMPROVED study enrolled 610 early rheumatoid arthritis (RA, 2010) or undifferentiated arthritis (UA) patients. All started induction therapy methotrexate (MTX) and tapered high dose of prednisone. If DAS-remission (<1.6) was achieved at 4 months prednisone was stopped (early DAS-remission (ER)) and if remission persisted at 8 months MTX was also stopped. Patients not in ER were randomized to MTX+sulfasalazine+hydroxychloroquine+low dose prednisone (arm 1) or MTX+adalimumab (arm 2), 50 patients were not randomized and were treated ‘outside of protocol’ (OP). Every 4 months treatment adjustments aimed at DAS<1.6: DAS<1.6 taper/stop medication and DAS≥1.6 restart/intensify. (Drug-free) DAS-remission percentages were compared between the different diagnosis and treatment strategies. Radiologic damage progression (Sharp-vanderHeijde Score, SHS) from baseline to 5 years was scored by 2 independent readers in chronologic order.
Results: Patients in the ER group had better functional ability over time, compared to arms 1 and 2 and the OP group, who between them had similar HAQ scores over time (figure). 295/610 (48%) patients achieved DAS-remission at 5 years: 220/387 (57%) in the ER group, 31/83 (37%) in arm 1, 29/78 (37%) in arm 2 (p=0.768 arm 1 vs arm 2) and 15/50 (30%) in OP (figure). 134/610 (22%) patients achieved DFR (drug-free DAS-remission): 105/387 (27%) in the ER group, 9/83 (11%) in arm 1, 12/78 (15%) in arm 2 (p=0.374 arm 1 vs arm 2) and 8/50 (16%) in OP (figure). DAS-remission percentages were similar in RA and UA patients and autoantibody positive (+) vs negative (‒) patients. More UA patients achieved DFR (33% UA vs 19% RA, p<0.001), and more patients negative for anti-citrullinated protein antibodies (ACPA) (31% ACPAneg vs 15% ACPApos, p<0.001) or rheumatoid factor (RF) (28% RFneg vs 17% RFpos, p<0.001) achieved DFR. Median (IQR) SHS progression was 0.5 (0-3) in 306 completers in the ER group, 0 (0-1) in arm 1 (62 completers), 0 (0-1) in arm 2 (59 completers) (p=0.818 arm 1 vs arm 2) and 0 (0-3) in 31 OP completers. SHS progression ≥5 points had occurred in 40/306 (13%) in the ER group, 9/62 (15%) in arm 1, 7/59 (12%) in arm 2 (p=0.710 arm 1 vs arm 2) and 2/31 (6%).
Conclusion: Induction therapy followed by 5 years DAS-remission steered treatment resulted in 48% DAS-remission and 22% DFR in early RA and UA patients. More UA patients and more autoantibody negative patients achieved DFR. Radiologic damage progression was well suppressed in the majority of patients.
To cite this abstract in AMA style:Akdemir G, Heimans L, Goekoop RJ, van Oosterhout M, Harbers JB, Bijkerk C, Steup-Beekman GM, Lard LR, de Sonnaville PBJ, Grillet BAM, Huizinga T, Allaart CF. Clinical and Radiological Outcomes of 5 Years Remission Steered Treatment in Early Rheumatoid and Undifferentiated Arthritis Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/clinical-and-radiological-outcomes-of-5-years-remission-steered-treatment-in-early-rheumatoid-and-undifferentiated-arthritis-patients/. Accessed October 28, 2020.
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