PARIS, France—As many as half of all early rheumatoid arthritis patients may achieve remission within 36 weeks following step-up treatment coupled with tight control, according to new research presented at the annual European League Against Rheumatism meeting in Paris, France.1

Ina Kuper, MD

"Our data show that also in daily clinical practice it is possible to achieve low disease activity state as well as remission in RA."—H. H. (Ina) Kuper, MD

"Our data show that also in daily clinical practice it is possible to achieve low disease activity state as well as remission in RA," conclude the researchers led by H. H. (Ina) Kuper, MD, of Medisch Spectrum Twente and University Twente, Almelo, The Netherlands. Moreover, "remission is achieved rapidly in a considerable percentage of patients with recently onset RA using a tight step-up DMARD treatment scheme aiming at remission."

Rapid remission achieved in real world setting

The new prospective study comprised 169 DMARD-naïve, early RA patients from the Dutch Rheumatoid Arthritis Monitoring Registry. Remission was defined as a Disease Activity Score 28 (DAS28) of <2.6, for which 15.5% of patients achieved this score by week 8, 22.2% achieved this score by week 12, and 30.7% by week 20. Furthermore, the study showed that 38.8% achieved remission by week 24, 52.1% by week 36, and 51% by weeks 48 to 52.


Baseline patient characteristics were comparable: 57.3 years was average patient age, 63.9% were female, and 52.7% were rheumatoid factor positive. Patients’ average disease duration was 16 weeks.

Step-up, tight control regimen defined

Patients received 15 mg/week of methotrexate (MTX) following diagnosis. If remission was not achieved at week 8, MTX dose was increased to 25 mg/week. If remission was not achieved at week 12, sulfasalazine (SSZ) 2 g/day was added. If by week 20 remission was not achieved, SSZ was increased to 3 g/day. If at week 24 remission still remained elusive, adalimumab was added to MTX. Therapy could be adjusted every 3 months based on DAS28. Thereafter, other TNF-blockers may be tried. Patients were allowed to take nonsteroidal anti-inflammatory drugs, prednisolone ≤10 mg/day, and intra-articular corticosteroid injections could be administered.

Reference

1. Kuper HH, Hoekstra M, ten Klooster P, et al. Remission can be achieved in 50% of early rheumatoid arthritis patients after 25 weeks in daily clinical practice. Presented at: EULAR 2008; June 11-14, 2008; Paris, France. Abstract OP-0003.