Background Recently, a tight control strategy with treat to target (T2T) is this worldwide to achieve remission, and to inhibit joint damage, in rheumatoid arthritis (RA) patients. However, little is known about the rate of remission or the inhibitory effect on joint damage with non-biological DMARDs (non-Bio) in routine clinical practice.
Objectives To investigate the rate of remission and the inhibitory effect on joint damage by non-Bio mono- or combination therapy for RA in routine clinical practice.
Methods In 555 patients with newly registered RA during 3.5 years, the outcome of induction of remission by mono- or combination therapy with non-Bio was analyzed retrospectively. Patients were treated initially with non-Bio monotherapy, including methotrexate (MTX), and changed to MTX combination therapy if monotherapy was not effective. They were evaluated clinically by DAS28 (ESR) approximately every 3–4 months, and designated as in remission when they satisfied DAS <2.6 on two successive occasions. We excluded patients who were in remission before therapy. The inhibition of joint damage was assessed radiographically using the total Sharp/van der Heijde scoring (SHS).
Results Among 538 RA patients, remission was achieved in 89 (58 cases of monotherapy, 31 cases of MTX combination therapy. Following monotherapy, the DAS28 improved from 4.54 to 1.87 (mean age, 58 years; mean duration of disease, 32 months; mean time to remission, 17.8 months). As well as MTX (n=18), the drugs used were salazosulfapyridine (SSZ: n=20), bucillamine (BUC: n=19), and leflunomide (LEF: n=1). The remission rates were 7.1% (20/282) for SSZ, 11.9% (17/142) for BUC, and 23.9% (17/71) for MTX. The SHS/year changed from 6.3 to 0.04 (P<0.10), from 33.6 to 0.49 (P<0.01), and from 6.51 to 2.06 (P<0.05), respectively. Following combination therapy, the DAS28 improved from 4.70 to 1.89 (mean age, 52.6 years; mean duration of disease, 38 months; mean time to remission, 15.0 months). The drugs used in combination with MTX were BUC (n=14), LEF (n=8), tacrolimus (TAC: n=8) and SSZ (n=1). The remission rates were 6.8% (14/204) for MTX+BUC, 23.5% (8/34) for MTX+LEF, and 10.7% (8/75) for MTX+TAC. SHS/year changed from 12.8 to 1.39 (P<0.10), from 15.7 to –1.64 (P<0.20), and from 7.1 to 0.31 (P<0.10), respectively.
Conclusions Satisfactory inhibition of joint destruction was seen in RA patients with remission using non-BIO mono- or MTX combination therapy in routine clinical practice. We can anticipate that use of the T2T strategy will lead to improved remission rates and inhibition of joint destruction in RA.
Disclosure of Interest None Declared
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