Published on the May 16, 2016, Rheumatology Network website
By Whitney L.J. Howell
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.
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).
To see the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/early-treatment-early-ra-leads-better-outcomes
