Low Disease Activity vs Remission: Which to Target in RA?

In patients with rheumatoid arthritis (RA), targeting treatment towards achieving remission is associated with improved outcomes compared with a target geared towards achieving low disease activity, according to a new study.

For their study, the researchers assessed 133 patients with early active RA, beginning with methotrexate, sulfasalazine and a tapered high dose of prednisone (arm 3 of the BehandelStrategieën Treatment Strategies for Rheumatoid Arthritis [BeSt] study).
____________________________________________________________________________

RELATED CONTENT
Mental Health Could Predict RA Flare
RA: Sarilumab Deemed Safe for Long-Term Use
____________________________________________________________________________

In this group, treatment was targeted towards achieving low disease activity—defined as a Disease Activity Score (DAS) of 2.4 or less.

The researchers also evaluated a second group of 175 patients with early RA who were enrolled in the IMPROVED study and would have fulfilled inclusion criteria of the BeSt study. In this group, patients started methotrexate and a tapered high dose of prednisone. Treatment was targeted towards remission—defined as a DAS of less than 1.6.

Logistic regression analysis was used to examine the association of each treatment target with a DAS of less than 6, Boolean remission at year 1, and drug-free DAS remission (DFR) at year 5.

Results showed that, at baseline, the group geared towards a DAS of less than 1.6 had milder disease and less radiological damage compared with those with a DAS target of 2.4 or less.

The researchers found that DAS decrease, functional ability and radiological damage progression over time were similar in both treatment groups.

However, they observed higher rates of achieving a DAS of less than 1.6 (odds ratio [OR] 3.04), and Boolean remission at year 1 (OR 3.03), and DFR at year 5 (OR 3.77) in the group geared towards a DAS of less than 1.6 compared with the group with a DAS target of 2.4 or less.

“In patients with early active RA who start with comparable disease-modifying antirheumatic drug+prednisone combination therapy, subsequent DAS [of less than 1.6] steered treatment is associated with similar clinical and radiological outcomes over time as DAS [of 2.4 or less] steered treatment; however, in the DAS [of less than 1.6] steered group, more patients achieved remission and drug-free remission,” the researchers concluded.

—Christina Vogt

Reference:

Akdemir G, Markusse IM, Bergstra SA, et al. Comparison between low disease activity or DAS remission as treatment target in patients with early active rheumatoid arthritis [Published online May 20, 2018]. RMD Open. http://dx.doi.org/10.1136/rmdopen-2018-000649