Background To achieve comprehensive disease control (CDC; defined as simultaneous achievement of DAS28 <3.2, HAQ-DI <0.5 and ΔmTSS ≤0.5) or comprehensive disease remission (CDR; defined as simultaneous achievement of DAS28 <2.6, HAQ-DI <0.5 and ΔmTSS ≤0.5) is our therapeutic goal of treating RA. Owing to early diagnosis of RA based on the 2010 ACR/European League Against Rheumatism classification criteria (1), it is more likely that the disease activity is controlled by only synthetic disease-modifying anti-rheumatic drugs (sDMARDs), however, there is no firm evidence to show if the function and bone structure in the RA patients whose disease activity is controlled by only sDMARDs are maintained without their damages for a long time.
Objectives To compare 161 patients who showed adequate responses to methotrexate (MTX) (MTX group) with 96 patients treated with adalimumab (ADA) + MTX to inadequate response to MTX (MTX-IR) (ADA group) about the effects on functional and structural outcomes for 3 years.
Methods Grip strength, CDR and CDC rates and patients' proportions with structural remission (ΔmTSS ≤0.5), clinical relevant radiographic progression (CRRP; ΔmTSS >3) and rapid radiographic progression (RRP; ΔmTSS>5) were measured in MTX group (n=161, mean disease duration: 4.4 years) or ADA group (n=96, mean disease duration: 8.5 years) every year, for 3 years.
Results There was no significant difference in clinical remission rates (DAS28-ESR<2.6) between MTX and ADA groups at 3 years (LOCF). While, CDR rates for 3 years were much higher in ADA group (43.2%) than MTX group (18.3%) as well as those of CDC (45.9% vs. 24.0%, respectively). Moreover, about the structural change, ratios of patients with RRP were decreased in both MTX and ADA group at 3 years compared to the status at first year, however the ratio of patients with RRP in MTX group was 10% whereas that of patients with RRP in ADA group was 3%. Reflecting this result about the structural change, grip strength in ADA group was improved every year, but that was gradually decreased in MTX group after 1 year, even the baseline grip strength in MTX group was much stronger than that in ADA group (143 vs. 177 mmHg, p=0.0001).
Conclusions It was demonstrated that grip strength gradually decreased from 1 year after initiation of MTX treatment even in the patients who were managed RA disease for 3 years with MTX alone, while ADA treatment to MTX-IR patients improved grip strength time dependent manner, which was supported by the significantly better inhibitory effect on radiographic progression with higher CDC and CDR rates over 3 years in ADA group than those in MTX group. In summary, from our study in site, it is suggested ADA treatment by defining the patients who would better to start the treatment with biologics as early as possible, based on the concept of Treat To Target, would be a key for patients to achieve higher therapeutic goals.
Aletaha D et al, Ann Rheum Dis. 2010;69(9):1580-8.
Disclosure of Interest None declared