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Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial
  1. T M Kuijper1,2,
  2. J J Luime2,
  3. P H P de Jong1,
  4. A H Gerards3,
  5. D van Zeben4,
  6. I Tchetverikov5,
  7. P B J de Sonnaville6,7,
  8. M V van Krugten6,8,
  9. B A Grillet9,10,11,
  10. J M W Hazes2,
  11. A E A M Weel1,2
  1. 1Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
  2. 2Department of Rheumatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  3. 3Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
  4. 4Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
  5. 5Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  6. 6Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands
  7. 7Reumazorg Zuid West Nederland, Goes, The Netherlands
  8. 8Reumazorg Zuid West Nederland, Vlissingen, The Netherlands
  9. 9Department of Rheumatology, Admiraal de Ruyter Hospital, Vlissingen, The Netherlands
  10. 10Department of Rheumatology, ZorgSaam Hospital, Terneuzen, The Netherlands
  11. 11Reumazorg Zuid West Nederland, Terneuzen, The Netherlands
  1. Correspondence to T M Kuijper, Department of Rheumatology, Maasstad Hospital, Maasstadweg 21, Rotterdam 3079 DZ, The Netherlands; kuijpert{at}


Objectives With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up.

Methods Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses.

Results During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification.

Conclusions Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively.

Trial registration number ISRCTN26791028; Post-results.

  • Early Rheumatoid Arthritis
  • DMARDs (synthetic)
  • DMARDs (biologic)
  • Disease Activity
  • Treatment

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  • Handling editor Tore K Kvien

  • Contributors All authors meet the criteria for authorship as stated in the ICMJE recommendations.

  • Funding This work was supported by an unrestrictive grant from Pfizer B.V. [0881-102217]. Pfizer had no involvement in the study design; in collection, analysis and interpretation of data; writing of the report, and decision to submit for publication. The corresponding author had full access to all data and had final responsibility for the decision to submit for publication. Data management was sponsored by the Dutch Arthritis Foundation.

  • Competing interests None declared.

  • Ethics approval Medical ethics committee of the Erasmus Medical Center, Rotterdam.

  • Provenance and peer review Not commissioned; externally peer reviewed.