Background Randomised trials have demonstrated that Treat to Target strategies in early rheumatoid arthritis (RA), that aim for at least low disease activity, produce significantly better short-term disease activity, radiographic and functional outcomes than less intensive strategies based on physician's judgement
Objectives To determine whether successive studies of intensive early RA treatment strategies from a single centre have shown similar improvements in disease activity and functional ability over the last 20 years
Methods Common demographic, disease activity and functional ability data were gathered from the Tight Control of RA (TICORA 1999-2001, n=111, routine vs intensive therapy)1, Triple Therapy in Early Active RA (TEAR 2003-2005, n=96,step-up vs parallel DMARD escalation)2 and Targetting Synovitis in Early RA (TaSER 2009-2012, n=111, DAS28 vs musculoskeletal ultrasound-driven step-up escalation)3 study files. For the TEAR study DAS28ESR scores were converted to DAS44ESR value using the formula DAS44ESR=(DAS28ESR-0.938)/1.072
Results Baseline demographic features and sero-positivity rates were similar between the studies. Patients in the older studies presented with significantly longer symptom duration than the TaSER study (mean [SD] TICORA=20  vs TEAR 11  vs TaSER 5  months respectively, p<0.0001), and had higher baseline disease activity and physical disability (Table1).
Treatment Response: All intensive treatment groups exhibited a significantly greater improvement in DAS44 than the TICORA Control group. After 12-18 months DAS44 scores were similar between the intensive treatment groups and significantly better than the TICORA control group (Graph1a). DAS44 remission rates were similar between the intensive treatment groups and consistently higher than the TICORA Control group at all time points.
Functional Ability: The HAQ scores for both TaSER groups were significantly better than both TEAR groups after 12 months and both TICORA groups after 18 months (Graph1b). Further, all intensive treatment groups exhibited a similar improvement in HAQ over the follow-up period (Table1)
Conclusions Intensive step-up and parallel DMARD escalation strategies produce similar short-term disease activity outcomes and improvements in functional ability that are significantly better than non-targeted therapy. RA groups that present with longer symptom durations and higher levels of disease activity and functional impairment, may exhibit greater improvements in disease activity, but may not regain functional ability to the same degree as groups who present earlier, with lower levels of disease activity
Grigor et al. Lancet 2004; 364: 263-69
Saunders et al. Arth Rheum 2008; 58: 1310-17
Dale et al. Arth Care Res 2014; 66: 19-26
Disclosure of Interest J. Dale Grant/research support from: Pfizer UK, Paid instructor for: Abbvie, A. Stirling: None declared, C. Grigor: None declared, S. Saunders: None declared, D. Porter Grant/research support from: Pfizer UK