Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Three Months of Therapy with DMARDs Is an Inadequate Period of Time To Alter the Treatment in Patients with Early Rheumatoid Arthritis When Treating to a Target of Low Disease State or Remission. Results from Canadian Early ArThritis CoHort (CATCH).
Akhavan4, Pooneh, Bykerk5, Vivian P., Sun6, Ye, Hochman12, J., Pope9, Janet E., Hitchon1, Carol A., Boire10, Gilles
Arthritis Center, University of Manitoba, Winnipeg, MB, Canada
Universite de Sherbrooke, Sherbrooke, QC, Canada
University of Toronto, Toronto, ON, Canada
University of Toronto, Toronto, ON
Institut de Rhumatologie, Montreal, QC, Canada
Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
Mt Sinai Hospital, Toronto, ON, Canada
Mt Sinai Hospital, Toronto, ON, Canada
Rheumatology, Hopital Maisonneuve, Rosement, University of Montreal, LaSalle, QC, Canada
Southlake Regional Health Care, Newmarket, ON, Canada
St Joseph Health Care London, London, ON, Canada
The objective of this study was to evaluate the concept of therapy alteration in patients with early rheumatoid arthritis (ERA) not achieving an adequate response by 3 months in a prospective cohort.
The study was designed to assess whether 3 months was an adequate time for decision-making regarding altering therapy in ERA patients who have been on stable DMARDs for 6 months and have not achieved low disease activity state (LDAS) or remission (REM).
Patients with ERA were studied in the Canadian Early Arthritis Cohort (CATCH), a prospective cohort where data was collected according to a standardized protocol. Patients who were on stable DMARDs therapy (with no dose adjustments after one month of initiating therapy and not receiving oral or parenteral steroids) for 6 months were evaluated. Patients not achieving LDAS or REM by 3 months were examined for the proportion of those achieving LDAS or REM by 6 months. We also evaluated patients achieving LDAS or REM by 6 months who had not achieved these outcomes by 3 months.
108 patients were evaluated with the baseline mean age of 50 years and disease duration of 6.3 months. Mean patient global assessment of disease activity, pain score and HAQ-DI were 61.2, 65.0 and 1.0 respectively at baseline. At 3 months, 46% and 31% of patients achieved LDAS or REM respectively, while 65% and 52% achieved these states by 6 months. Of 58 patients not in LDAS at 3 months, 26 (45%) achieved LDAS by 6 months. Of 74 patients not in REM by 3 months, 29 (40%) achieved REM by 6 months. Of 56 patients who achieved REM by 6 months, only 27 (48%) achieved it by 3 months.
Although baseline swollen joint count, tender joint count and CRP levels were not significantly different in two groups, patients who achieved LDAS at 6 months had higher pain (71±17 vs 47±32, p< 0.05) and patients global assessment (77±18 vs 53±32, p<0.05) scores at baseline compare to those achieved this state at 3 months. In patients with delayed remission (at 6 months) in addition to the above outcome measures, HAQ-DI (0.6±0.6 vs 1.1±0.6, p=0.003) was higher at baseline when compared to patient who achieved remission at 3 months.
While remaining on a stable therapy through 6 months, a substantial proportion of patients who had not achieved an adequate clinical response (LDAS or REM) by 3 months achieved these states by 6 months. Attention should be given to patient reported outcomes when assessing patients with ERA for risk of delayed remission. The data in this real world setting suggest that in a significant number of patients, 3 months was not an adequate period of time to decide on altering therapy based on whether an adequate clinical response had been achieved. Our results support recent guidelines suggesting that a 3 to 6 month time frame is required for optimal treatment decision making when treating to an LDAS or REM target.
To cite this abstract, please use the following information:
Akhavan, Pooneh, Bykerk, Vivian P., Sun, Ye, Hochman, J., Pope, Janet E., Hitchon, Carol A., et al; Three Months of Therapy with DMARDs Is an Inadequate Period of Time To Alter the Treatment in Patients with Early Rheumatoid Arthritis When Treating to a Target of Low Disease State or Remission. Results from Canadian Early ArThritis CoHort (CATCH). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :343