Background/Purpose: Guidelines recommend to treat newly diagnosed Early Rheumatoid Arthritis (ERA) with intensive treatment strategies using Methotrexate (MTX) or a combination of csDMARDs and a short course of glucocorticoids (GCs). However, patient characteristics predicting response to such treatments are unknown.

Methods: The Care in ERA (CareRA) trial compares remission induction regimens in a treat-to-target approach. DMARD naïve ERA patients were stratified into a high- or low-risk arm based on classical prognostic markers. High risk patients were randomized to COBRA Classic (MTX + Sulphasalazine + prednisone step-down from 60mg), COBRA Slim (MTX + prednisone step-down from 30mg) or COBRA Avant-Garde (MTX + Leflunomide + prednisone step-down from 30mg). Low risk patients were randomized to MTX tight step-up (MTX-TSU) without oral GCs, or COBRA Slim. Prednisone was tapered down over 6 weeks to 7.5mg in Classic and 5mg in the other COBRA arms. Oral GCs were stopped at week 34. Demographics were routinely registered. Treatment response was defined as achieving remission at Week52 (DAS28(CRP))<2.6). Firstly, differences in age, smoking status, alcohol status, BMI and gender between responders and non-responders were analyzed with χ² or Mann Whitney U tests where appropriate. Secondly, these patient characteristics were analyzed in a multivariate logistic regression model predicting response. Treatment strategy was put in the model to correct for any treatment differences. This analysis was intention-to-treat using all patients recruited at baseline and carrying last observation forward in case of missing data. A significance level of 0.05 was used.

Results: This analysis included 379 patients. Remission at Week52 was achieved in 62.3% of patients. The population reflected a typical Belgian ERA cohort aged 51.9 ±13.0 years with an average BMI of 26.4 ±4.2 kg/m², with 69.1% women, 25.6% current smokers and 56.2% drinking alcohol. No differences in gender, smoking status, alcohol status and age were found between responders and non-responders. BMI did however differ (p=0.036): individuals not responding to therapy had a higher BMI compared to responders (27.1 ±4.8 vs 26.0 ±3.8 ). Multivariate logistic regression confirmed these findings. Only BMI was statistically significantly related to treatment response (p=0.007, Odds Ratio (95%CI) = 0.934 (0.889-0.982)).

Conclusion: Intensive treatment strategies based on MTX or combinations of csDMARDs with short term glucocorticoids lead to high response rates. Chances of patients with a higher BMI to achieve remission after 1 year of treatment with these strategies are however lower. These results should be taken into account when choosing the initial treatment strategy in early RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-characteristics-predicting-remission-using-intensive-treatment-strategies-in-early-rheumatoid-arthritis/