Session Type: Abstract Submissions (ACR)
To compare the clinical, radiological and functional efficacy of initial versus delayed introduction of strategy which is treat-to-target to patients with recent onset rheumatoid arthritis (RA) after 2-years follow up.
A post hoc analysis of the T-4 (treating to twine targets) study which is a multicenter, randomized and open trial in newly diagnosed RA patients (mean duration 1.4±1.1 yrs) who has not previously received disease-modifying anti-rheumatic drugs (DMARDs) was performed. In the T-4 study, a total of 243 RA patients were randomly allocated to one of four strategy groups: routine care (R group, n=62); disease activity score in 28 joints (DAS28)-driven therapy (D group, n=60); matrix metalloproteinase (MMP)-3-driven therapy (M group, n=60); or both DAS28- and MMP-3-driven therapy group (Twin; T group, n=61). Specifically, medication was started with sulfasalazine (1 g/day) in all intervention groups. Targets were DAS28 <2.6 for D group, MMP-3 normalisation for M group, and both DAS28 <2.6 and MMP-3 normalisation for T group. If the value in question did not fall below the previously measured level, we intensified medication including methotrexate, other DMARDs and biologic agents. From 56 weeks all patients were allocated to T group, treatment was adjusted every three months if the value in question did not fall below the previously measured level. 61patinets in initial treat-to-target introduced group (T→Tgroup) were compared with 62 patients in delayed treat-to-target introduced group (R→Tgroup) for 2 years. Functional ability was measured by the Health Assessment Questionnaire (HAQ), radiological progression was measured by Sharp/van der Heijde scoring (SHS).
Results: Baseline differences between the two groups were not significant. Clinical (simplified disease activity index≤3.3) and functional (HAQ=0) remission at 2 years was achieved by more patients in initial treat-to-target introduced group (T→Tgroup) (51% and 74%) than in delayed group (R→T group) (18%; p<0.0001 and 50%; p=0.0063). There are no significant difference between initial and delayed group (52% versus 47%; p=0.5283) for radiographic remission (DSHS<0.5).
The results of post hoc analysis in T-4 study suggest that initial introduction of treat-to-target strategy in patients with recent onset RA is more effective than delayed introduction of strategy with more clinical and functional remission achieved for 2-years.
K. I. Furukawa,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/initial-introduction-of-treat-to-target-strategy-in-patients-with-recent-onset-rheumatoid-arthritis-is-more-effective-than-delayed-introduction-of-strategy-with-more-clinical-and-functional-remission/