Background/Purpose: Early effective treatment has led to major improvements in patients with rheumatoid arthritis (ERA). Low disease activity and remission are achieved earlier and in higher frequency when the initial treatment in rheumatoid arthritis includes a combination of methotrexate (MTX) with a bDMARD compared to MTX alone.

The aim of this study is to retrospectively analyse and compare the benefit of a treatment with methotrexate (MTX) alone or combined with a bDMARD as an induction therapy during 5 years of follow-up in early rheumatoid arthritis (ERA) patients.

Methods: We included ERA patients from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria and were naïve to DMARDs. Treatments were initiated based on the decision of a senior rheumatologist. bDMARDs induction therapy was usually limited to 6 or 12 months. We collected patient characteristics at baseline and clinical response was analysed at 6 months, 1 year, 3 years and 5 years.

Results: Data from 470 eligible ERA patients were collected. The average age of the population is 48.9 years; 70.5% of the patients are women; 27.3% are smokers and 68.8% are positive for anti-citrullinated protein antibody (ACPA). 281 patients (59.8 %) initiated MTX as a monotherapy (MTX group) compared to 189 patients (40.2%) who received a bDMARD (Bio group).

At baseline, the disease activity is the main factor that favors the initiation of bDMARDs (DAS28-CRP 5.2 vs 4.5, p< 0.001) followed by HAQ (1.32 vs 1.15, p=0.009), ACPA positivity (77.8% vs 62.5%, p=0.0006), rheumatoid factor positivity (71.5% vs 60.2%, p=0.0134). Other parameters such as age, gender, smoking habits or baseline erosion were similar between groups.

391 patients were followed up to 5 years. We then divided each of the two groups into two subgroups according to the last treatment they received at 5 years. Figure 1 shows the percentage of DAS28-CRP remission during time in each of the four groups (MTX- >MTX (n=134), MTX- >BIO (n=103); BIO- >MTX (n=95), BIO- >BIO (n=59);

At 12 months, DAS28-CRP response rate was statistically significantly higher in MTX >MTX and BIO >MTX groups compared to the two other groups. As expected, the remission rate was rescued in the group MTX- >Bio after 12 months.

Interestingly, ERA patients initially treated by a bDMARD followed by a MTX maintenance therapy experienced a stable and sustained rate of remission.

Conclusion: Longterm remission is an achievable goal in ERA followed in daily clinic. Our results suggest that a bDMARD induction therapy followed by MTX maintenance therapy could be a good option in severe case of ERA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/should-we-use-biodmards-in-first-intention-in-early-rheumatoid-arthritis-results-at-5-years-from-the-era-louvain-brussels-cohort/