Background According to Treat to Target (T2T) recommendations the primary goal of treatment of patients (pts) with rheumatoid arthritis (RA) is clinical remission. This implies a revision of treatment every 3-6 months with the use of combination therapy if necessary. Assessment of the results of applying the T2T strategy into practice is an important task.
Objectives To study the results of treatment according the T2T strategy in pts with RA in clinical practice.
Methods The REMARCA (Russian investigation of MethotrexAte and biologics in eaRly aCtive inflammatory Arthritis) investigator-initiated trial includes pts with asevere ctive RA. All pts started treatment with SC MTX monotherapy using fast increase from 10 to 25-30 mg/week. To exclude the influence of steroids, we allowed only 2 intra-articular injections per every 3 months (pts could continue steroids per os in low doses if prescribed before the enrollment in the study). Therapy was revised every 3 months using DAS28, SDAI and CDAI indices. The goal of treatment was clinical remission or low disease activity (LDA) as quickly as possible.
Results By January 2014, 210 pts with RA were included, and 88 pts have passed the 12 months control point (22 males, 66 females, 92% IgM RF positive, 87,5% anti-CCP positive, including 46 pts with early RA (duration≤6 months) and 42 pts with long-standing RA (duration 22 [11;53] months). At 6 months we achieved LDA or remission according to DAS28 in 43 (49%), SDAI in 53 (60%), CDAI in 55 (63%) of pts. At 12 months LDA or remission were observed by DAS28 in 54 (61%) of pts, SDAI – 65 (74%), CDAI in 67 (76%) of pts. Combination with biologics (in most cases TNF inhibitors) was used in 57 (65%) of pts at (median) 3 [3;6] month. There were 13 cases of switching between biologics. Remission was observed more often during the first 6 months among patients who did not require biological therapy, but at 12 month combination therapy group showed similar results (table 1). “Functional remission” (HAQ≤0,5) was observed significantly more frequently in patients with good initial response to SC MTX. Patients with early RA significantly less likely required treatment with biologics (52%) than patients with long-standing RA (79%, p=0,014).
Conclusions SC MTX monotherapy allowed to achieve LDA or remission in the vast majority of patients with good response to treatment. In patients who did not responded well to MTX (65%), combination with biological agents caused results, similar to “good responders”, in the medium-term period. Patients with early RA require much less biologics than patients with long-standing RA.
Disclosure of Interest : None declared