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Early Treatment for Early RA Leads to Better Outcomes

Initial combination therapy leads to faster clinical improvements in early rheumatoid arthritis making drug-free remission a realistic outcome.

Patients with early-active rheumatoid arthritis who receive initial or temporary combination therapies can experience faster clinical improvements than those who don’t, a new study found. These targeted treatments also determine long-term outcomes.

Existing research shows treat-to-target therapy works for rheumatoid arthritis patients, but little evidence exists that highlights the long-term impact of continued targeted treatment. The new study evaluated the long-term outcomes in early-active rheumatoid arthritis patients after 10 years of targeted treatments using four different strategies.

The April 2016 Annals of Internal Medicine study found drug-free remissions - with prevention of functional deterioration and clinically-relevant radiographic damage - and normalized survival are realistic outcomes for rheumatoid arthritis patients.

In the randomized-trial, 508 early-active rheumatoid arthritis patients received a combination of four different strategies: (1) sequential monotherapy, (2) step-up combination therapy, (3) initial combination therapy with prednisone, or (4) infliximab. All strategies were followed by targeted treatments that aimed at low disease activity.  [[{"type":"media","view_mode":"media_crop","fid":"48655","attributes":{"alt":"©ImagePointFr/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_7255628190415","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5832","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©ImagePointFr/Shutterstock.com","typeof":"foaf:Image"}}]]

The endpoints were functional ability (measured by the Health Assessment Questionnaire (HAQ) score) and radiographic progression (Sharp-Van Heijde score). Survival in the study was compared with the general population using the standardized mortality ratio.

According to study results, 195 patients – 38 percent of the participating population – dropped out of the study. Twenty-eight percent were from strategy 4 compared to 40 percent to 45 percent in strategies 1 and 3, respectively.

At year 10, 53 percent and 14 percent were in remission and drug-free remission, respectively, without experiencing any differences among strategies. During the same time, mean HAQ scores were 0.69, 0.72, 0.64, and 0.58 in strategies 1 through 4, respectively.

Sharp van-der Heijde estimates during follow-up were 11, 8, 8, and 6 for strategies 1 through 4, respectively. Standardized morality ratio was 1.16 (95% CI, 0.92 to 1.46) based on 72 observed and 62 expected deaths. There were similar survival rates among all four strategies (P=0.81).



Iris M. Markusse, MD, PhD; Gülşah Akdemir, MD; et al.

"Long-Term Outcomes of Patients With Recent-Onset Rheumatoid Arthritis After 10 Years of Tight Controlled Treatment: A Randomized Trial,"

Annals of Internal Medicine. April 19, 2016.  doi:10.7326/M15-0919