Treat-to-Target May Wipe Out Added Mortality Risks in RA

Markusse IM, Dirven L, J.H. van Groenendael JH, et. al., Mortality in a Large Cohort of Patients with Early Rheumatoid Arthritis That Were Treated-to-Target for 10 Years. ACR Abstract # 817. Arthritis & Rheumatism. 2014;66(1)-Supplement.

An early treat to target strategy aimed at low disease activity in rheumatoid arthritis (RA) patients appears to eliminate any extra risk of death that might be attributed to the disease, according to a Dutch study.

“After 10 years, we found an overall standardized mortality ratio of 1.16 for the RA patients, which was not statistically significant from the Dutch general population, which means mortality was essentially the same,” explained lead investigator Iris J.M. Markusse MD of the department of rheumatology at Leiden University Medical Center in The Netherlands, speaking at the 2014 meeting of the American College of Rheumatology.

High rates of success with treat-to-target probably account for these results, she added. Nearly half of subjects reached remission.

The Behandel Strategieen (BeSt) Study was a randomized clinical test of four diffferent treat-to-target therapies among 508 patients with recent-onset active RA.

Patients in treatment arms 1 and 2 started with methotrexate (MTX) monotherapy and switched to or added other medications if needed. The other two arms tested MTX combined with either sulfasalazine plus prednisone or infliximab (Remicade). Tapering to  monotherapy was an option if clinical response was sufficient.

Around 80% of the BeSt patients are in low disease activity, defined as a disease activity score (DAS) of 2.4 or lower, while 45% are in remission, and 15% are in drug-free remission.

“These patients were tightly controlled with very well-suppressed disease activity," Markusse added. "Although we had no control group, we think treat-to-target might have resulted in longer survival."

In both the study population and the Dutch population in general, independent risk factors for mortality are age, male gender, smoking, and functional disability.

To "wish" long lives for your RA patients, the team concludes, treat them all early and aggressively to a target of low disease activity-and encourage them to quit smoking.