Article Text

other Versions

PDF
Extended report
Response to glucocorticoids at 2 weeks predicts the effectiveness of DMARD induction therapy at 3 months: post hoc analyses from the tREACH study
  1. Pascal Hendrik Pieter de Jong1,
  2. Rogier A Quax2,
  3. Margriet Huisman3,
  4. A H Gerards4,
  5. Richard A Feelders2,
  6. Peter B de Sonnaville5,
  7. Jolanda J Luime1,
  8. Angelique E Weel1,6,
  9. J M Hazes1
  1. 1Department of Rheumatology, University Medical Center, Rotterdam, Zuid-holland, The Netherlands
  2. 2Department of Endocrinology, University Medical Center, Rotterdam, Zuid-holland, The Netherlands
  3. 3Department of Rheumatology, Sint Francicus Gasthuis Hospital, Rotterdam, Zuid-holland, The Netherlands
  4. 4Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
  5. 5Department of Rheumatology, Admiraal de Ruyter Hospital, Vlissingen, Netherlands
  6. 6Department of Rheumatology, Maasstad Hospital, Rotterdam, Zuid-holland, Netherlands
  1. Correspondence to Dr Pascal Hendrik Pieter de Jong, Erasmus MC, Room Ee963a, Postbus 2040, Rotterdam 3000CA, The Netherlands; p.h.p.dejong{at}erasmusmc.nl

Abstract

Objective To investigate if a glucocorticoid (GC) response at 2 weeks, defined by EULAR response criteria, can predict active disease (Disease Activity Score (DAS)>2.4) at 3 months.

Methods For this study, data of the Treatment in the Rotterdam Early Arthritis Cohort study (tREACH), an ongoing clinical trial that evaluates different induction therapies in early rheumatoid arthritis, were used. We selected patients who had a high probability of progressing to persistent arthritis (>70% based on the prediction model of Visser). All patients within the high-probability stratum, who had a baseline DAS>2.2 and a DAS assessment at 2 weeks after randomisation, were included (n=120). Besides GC response at 2 weeks, we investigated which other factors were associated with active disease (DAS>2.4) after 3 months of disease-modifying antirheumatic drug (DMARD) treatment. All variables with a p≤0.25 were assessed in our logistic regression model with backward selection. Variables were eliminated until all remaining variables had a significant association (p<0.05).

Results Patients who did not respond to GC bridging therapy at 2 weeks had an overall OR of having active disease at 3 months of 10.29 (95% CI 3.34 to 31.64; p<0.001) in comparison with responders. The corrected OR was 14.00 (95% CI 3.31 to 59.21; p<0.001). Our final model predicting response at 3 months included the following variables: gender, GC response, induction therapy arms and baseline DAS, which had an explained variance of 39%.

Conclusions GC response at 2 weeks is a useful tool for recognising those patients who will probably have active disease (DAS>2.4) after 3 months of DMARD treatment.

  • Early Rheumatoid Arthritis
  • Disease Activity
  • Treatment
  • Corticosteroids

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.