Two-year results of disease activity score (DAS)-remission-steered treatment strategies aiming at drug-free remission in early arthritis patients (the IMPROVED-study)

Arthritis Research & Therapy
Lotte HeimansCornelia F Allaart

Abstract

Early suppression of disease activity in (rheumatoid) arthritis (RA) patients may result in drug-free remission and prevent damage. We assessed 2-year clinical and radiological outcomes of two disease activity score (DAS)-remission-steered treatment strategies in early arthritis patients. Patients (n = 610) with early RA or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and tapered high dose of prednisone. Patients in early remission (44/53 joints DAS <1.6) after 4 months tapered and stopped medication. Patients who did not achieve early DAS-remission were randomized to either MTX plus hydroxychloroquine plus sulphasalazine plus low dose prednisone (arm 1) or to MTX + adalimumab (arm 2). At four-monthly intervals, medication was tapered and stopped if DAS was <1.6 but restarted, increased or switched if DAS was ≥1.6. Proportions of (drug-free) DAS-remission (DFR) after 2 years and Sharp-van der Heijde scores (SHS) were analyzed separately for the treatment strategies and patients with RA and UA. After 2 years, 301/610 (49 %) patients were in DAS-remission and 131/610 (21 %) in DFR. In the early remission group 241/387 patients (62 %) were in DAS-remission and 111/387 (29 %) DFR. In arm 1 22/83 (27 %) and i...Continue Reading

References

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Citations

Jul 2, 2016·Zeitschrift für Rheumatologie·J Detert, G R Burmester
Mar 4, 2017·Rheumatology and Therapy·Lise M VerhoefAlfons A den Broeder
Mar 22, 2018·Nature Reviews. Rheumatology·Vivian P Bykerk
Oct 5, 2017·Therapeutic Advances in Musculoskeletal Disease·Sofia Ajeganova, Tom Huizinga
Jul 27, 2018·Annals of the Rheumatic Diseases·Emma C de MoelDiane van der Woude
Nov 26, 2020·Rheumatology·Nathalie Luurssen-MasurelUNKNOWN tREACH group investigators
Jan 24, 2021·Rheumatology·N Luurssen-MasurelUNKNOWN tREACH group investigators
Mar 11, 2021·Joint, Bone, Spine : Revue Du Rhumatisme·Javier NarváezLoreto Carmona
Apr 10, 2021·European Journal of Internal Medicine·Fernando Luiz Barros EdingtonMittermayer Barreto Santiago
Dec 15, 2020·Arthritis & Rheumatology·Josephine A M P AmkreutzDiane van der Woude
Aug 6, 2021·Rheumatology·Nathalie Luurssen-MasurelUNKNOWN tREACH group investigators

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Methods Mentioned

BETA
ESR

Clinical Trials Mentioned

ISRCTN11916566

Software Mentioned

PROMPT
IMPROVED
SPSS

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