Treat-to-Target Clears RA in Real-World Clinical Care

Vermeer M, Kuper HH, Moens HJB, et al.Sustained Beneficial Effects of a Protocolized Treat-to-Target Strategy in Very Early Rheumatoid Arthritis: Three-Year Results of the Dutch Rheumatoid Arthritis Monitoring Remission Induction Cohort. Arthritis Care Res. (2013) 65:1219–1226. doi: 10.1002/acr.21984  

The majority of patients with very early rheumatoid arthritis (RA) treated in customary clinical practice can achieve sustained remission at three years with a treat-to-target regimen of mostly conventional disease modifying antirheumatic drugs (DMARDS), researchers say.

Among 342 patients in the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort, most of whom are women in their late 50s with high disease activity, 70.5% (n=241) show at least one period of sustained remission over 3 years on very early, intensive treatment.
A majority (85%, n=206) used conventional DMARDS such as methotrexate (MTX) and sulfasalazine (SSZ). Only 12% of patients (n=29) needed adjuvant therapy with anti-tumor necrosis alpha (anti-TNFα) drugs (adalimumab, infliximab) to achieve sustained remission.

Sustained remission was defined as a Disease Activity Score in 28 joints (DAS-28) of <2.6 during at least sixconsecutive months.

After three years, mean DAS28 decreased to 2.4 ± 1.0, with 61.7% (n=211) in DAS28 remission. After sustained remission, medication was 65% (n=158) of patients were able to taper their dosages and 18.7% (n=45) discontinued medication entirely.

A majority of patients had erosive disease at three years (76%), a significant increase over baseline. However, patients' perception of physical function and health-related quality of life improved, and most had limited radiographic damage.

While such a DAS28 remission treat-to-target regimen has not yet been implemented widely, the researchers conclude it can be successful -- and feasible -- in daily clinical practice.