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FRI0076 Low Disease Activity or DAS-Remission as Treatment Target in Early Rheumatoid Arthritis Patients
  1. G. Akdemir1,
  2. I.M. Markusse1,
  3. A.A. Schouffoer2,
  4. P.B. de Sonnaville3,
  5. B.A. Grillet4,
  6. P.J. Kerstens5,
  7. W.F. Lems5,6,
  8. T.W. Huizinga1,
  9. C.F. Allaart1
  1. 1Rheumatology, LUMC, Leiden
  2. 2Rheumatology, Haga Hospital, The Hague
  3. 3Rheumatology, ADRZ, Goes
  4. 4Rheumatology, Zorgsaam, Terneuzen
  5. 5Rheumatology, Reade
  6. 6Rheumatology, Amsterdam Rheumatology and immunology Centre VUMC, Amsterdam, Netherlands

Abstract

Background It is unknown what the optimum treatment target for early rheumatoid arthritis (RA) patients is.

Objectives To assess which treatment target, low disease activity or disease activity score (DAS)-remission is more effective in early RA patients.

Methods The BeSt study included early (≤2 years symptom duration) active (≥6 of 66 swollen joints, ≥6 of 68 tender joints, and either erythrocyte sedimentation rate ≥28 mm/hour or a visual analogue scale global health score ≥20mm) RA (1987 criteria) patients to compare 4 treatment strategies, targeted at DAS≤2.4. In arm 3 treatment started with a combination of methotrexate (MTX), sulfasalazine and a tapered high dose of prednisone. In the IMPROVED study, early arthritis patients started with MTX and a tapered high dose of prednisone, with subsequent treatment options aiming at DAS-remission (<1.6). We compared clinical outcomes during 5 years in 133 BeSt patients randomized to arm 3 with 175 IMPROVED patients who fulfilled the inclusion criteria of the BeSt study. Predictive factors for DAS<1.6 at year 1 and drug-free remission (DFR) at year 5 were assessed by logistic regression analysis.

Results At baseline IMPROVED patients had a significantly lower mean±SD DAS compared to BeSt patients (4.1±0.7 vs 4.4±0.9, p=0.012) and a shorter median (IQR) symptom duration (17 (8–28) vs 23 (15–53) weeks, p<0.001) (figure). At 3 months in the BeSt study, DAS decreased by 2 to 2.4±1.0, functional ability improved from 1.4±0.7 to 0.6±0.6, 56% of patients achieved DAS≤2.4 and 20% were in DAS-remission. At 4 months in IMPROVED patients, DAS decreased >2 to 1.8±1.0, functional ability improved from 1.5±0.6 to 0.5±0.6, 72% of patients achieved DAS≤2.4 and 53% were in DAS-remission. At year 1, DAS was decreased by 2.5 in IMPROVED and 2.4 in BeSt compared to baseline, to 1.6±1.0 and 2.0±0.9, p=0.004, and more IMPROVED patients than BeSt patients had achieved DAS<1.6 (51% vs 30%, p<0.001). Similar percentages in both studies achieved DAS≤2.4 (73% in IMPROVED vs 67% in BeSt, p=0.333). By protocol, BeSt patients could not achieve DFR at year 1. DFR was achieved in 15% of IMPROVED patients. At year 5, DAS was decreased by 2.7 in IMPROVED and 2.6 in BeSt compared to baseline, to 1.5±0.8 and 1.7±0.8, respectively (p=0.014). DAS≤2.4 was achieved in 61% of IMPROVED patients and in 61% of BeSt patients (p=0.092), DAS<1.6 was achieved in 43% vs 32%, p=0.003, and DFR was achieved in 18% vs 8%, p=0.003.

Predictive factors for DAS<1.6 at year 1 were type of treatment study (OR for IMPROVED (95% CI) 2.16 (1.27–3.68)), male gender (2.31 (1.34–3.98)) and baseline tender joint count (0.94 (0.90–0.99)). IMPROVED study (3.33 (1.44–7.66)) and absence of RF (rheumatoid factor) and ACPA (anti-citrullinated protein antibodies) 4.24 (1.71–10.51) were predictive factors for DFR at year 5.

Conclusions Although the treatment target was less often achieved for DAS<1.6 compared to DAS≤2.4, irrespective of baseline disease activity, patients with early active RA had better outcomes after DAS<1.6 than DAS≤2.4 targeted therapy. Male gender, low baseline tender joint count and absence of RF and ACPA were also associated with more favourable treatment outcomes.

Disclosure of Interest G. Akdemir: None declared, I. M. Markusse: None declared, A. A. Schouffoer: None declared, P. B. de Sonnaville: None declared, B. A. Grillet: None declared, P. J. Kerstens: None declared, W. F. Lems: None declared, T. W. Huizinga: None declared, C. F. Allaart Grant/research support from: Year 1 of the IMPROVED study was sponsored by Abbott. The BeSt study was designed by the investigators and supported by a government grant from the Dutch Insurance Companies, with additional funding from Schering-Plough B.V. and Janssen B.V. Data collection, trial management, data analysis and preparation of the manuscript were performed by the authors.

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