BARCELONA, Spain—Intensive treatment with conventional therapies—methotrexate (MTX) and intra-articular corticosteroid—stopped radiographic progression of erosions in patients with early rheumatoid arthritis (RA), according to data from the cyclosporine, methotrexate and steroid in rheumatoid arthritis (CIMESTRA) study presented at EULAR 2007, in Barcelona, Spain.1

In the new study, 160 patients with early RA (<6 months' duration) were randomized to receive either MTX+CyA (cyclosporine) (combination therapy) or MTX+ placebo/CyA (monotherapy) during the first 76 weeks. Patients also received intra-articular betamethasone in any swollen joint.

"Intensive treatment with MTX and intra-articular steroids minimized radiographic progression and the addition of CyA had no impact on radiologic outcome," said lead researcher Merete L. Hetland, MD, with Copenhagen University Hospital, in Denmark. However, combination therapy with low dose Cya did improve clinical outcome.

At week 68, hydroxychlorochine was added to the regimens of all patients, and from week 76 to 104 CyA/placebo was tapered, while step-up of MTX and intra-articular injections continued in patients with active disease.

Researchers took conventional radiographs of hands, wrists, and feet at baseline, 1, and 2 years. They were scored with the Sharp-van der Heijde method: total Sharp score (TSS), erosion score (ES), and joint space narrowing score (JSN) by one radiologist. Of the original cohort, 104 completed the 2-year study.

At baseline, 61% of patients had erosive RA. Disease activity score 28 (DAS28) was 5.7 in the MTX+placebo group at baseline versus 5.4 in the MTX+CyA group.

Additionally, 65% of CIMESTRA patients were rheumatoid factor positive and 59% were antiCCP positive.

The estimated yearly progression rate, based on disease duration and baseline Sharp scores for each patient, was 16 in the MTX+placebo group and 22 in the MTX+CyA group. The observed radiographic progression in both groups was reduced to a minimum at year 2.

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Reference

1. Hetland ML, Østergaard M, Vestergaard A, et al. Is it possible to stop radiographic progression with conventional treatment in early rheumatoid arthritis? 2-year results from the CIMESTRA study. EULAR 2007 Meeting; June 13-16, 2007; Barcelona, Spain. Abstract OP0127.