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.


Long-Term Remission in Daily Clinical Practice: Excellent 2 Year Results with Treatment To Target in Very Early Rheumatoid Arthritis, Results of the DREAM Remission Induction Cohort.

Vermeer5,  Marloes, Kuper5,  Ina H., Hoekstra1,  Monique, Moens6,  Hein J. Bernelot, Posthumus4,  Marcel D., Brus3,  Herman L. M., van Riel2,  Piet L. C. M.

Isala Klinieken, Zwolle, The Netherlands
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
TweeSteden Ziekenhuis, Tilburg, The Netherlands
University Medical Center Groningen, Groningen, The Netherlands
University of Twente and Medisch Spectrum Twente, Enschede, The Netherlands
Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands

Background:

Remission is the primary target of treatment of rheumatoid arthritis (RA). Clinical trials have proven that systematic monitoring of disease activity and adjusting medication on the basis of the disease activity outcome is effective in reaching this goal. Therefore, in current guidelines and recommendations on RA it has been advocated to treat RA to target. However, aiming for remission is not yet implemented and data on inducing and achieving remission in daily clinical practice are limited. The objective of this study was to evaluate disease activity in very early RA patients in daily clinical practice after 2 years of applying a tight control treatment strategy.

Methods:

Since January 2006, 534 newly diagnosed patients with early RA (clinical diagnosis of RA, symptom duration <= 1 year) were enrolled in the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort study. Treatment adjustments (4–8 weekly) were based on the DAS28, aiming at DAS28 < 2.6. The medication protocol consisted of initial MTX, addition of SSZ, exchange of SSZ by anti-TNF in case of insufficient response. Primary outcome was the disease activity according to the DAS28, EULAR response criteria and ACR criteria for clinical remission after 1 and 2 years. Additional outcomes included time to first remission and sustainability of remission.

Results:

Baseline characteristics were as follows: mean (SD) age 57.7 (13.9) years, 62.8% female, 56.6% RF positive, 62.4% anti-CCP positive, median (IQR) symptom duration 15 (8–26) weeks, mean (SD) baseline DAS28 5.0 (1.1) and 82.8% of patients fulfilled the ACR classification criteria for RA. Of all patients, 1 year follow-up data was available in 392 patients and 2 year data in 210 patients. At 1 year (n=392), 55.1% of patients achieved DAS28 remission, 64.8% had a good EULAR response and 45.1% satisfied the ACR remission criteria (Table 1). At 2 years (n=210), 64.3% of patients achieved DAS28 remission, 75.7% had a good EULAR response and 54.4% satisfied the ACR remission criteria (Table 1). Median (IQR) time to first DAS28 remission was 22 (12–37) weeks. In more than 60% (127/210) of patients sustained DAS28 remission (>= 6 months) was observed during the first 2 years of follow-up. The majority of patients achieved remission on conventional DMARDs (mono or combination therapy). Results were independent of the definition of RA (i.e. clinical diagnosis/ACR 1987 criteria) or presence of traditional prognostic factors for RA (i.e. RF/anti-CCP).

Table 1. Clinical outcomes alter 1 and 2 years.

 1 year (n = 392)2 year (n = 210)
DAS28  
  Remission (DAS28 < 2.6)216 (56.1)135 (64.3)
  Low (2.6 <= DAS28 <= 3.2)62 (15.8)37 (17.6)
  Moderate (3.2 < DAS28 <= 5.1)103 (26.3)32 (15.2)
  High (DAS28 > 5.1)11 (2.8)6 (2.9)
EULAR response  
  Good254 (64.8)159 (75.7)
  Moderate102 (26.0)35 (16.7)
  None36 (9.2)16 (7.8)
ACR remission143/317 (45.1)*93/171 (54.4)*
Values are presented as number (%). *ACR remission could not be evaluated in all patients, due to missing values for morning stiffness.

Conclusion:

This study shows that long-term remission is a realistic goal in very early RA patients in daily clinical practice. Implementation of a tight control treatment strategy results in rapid and high remission rates, regardless of the definition used. The management of very early RA patients in clinical care can go beyond the control of signs and symptoms, and should aim at remission.

To cite this abstract, please use the following information:
Vermeer, Marloes, Kuper, Ina H., Hoekstra, Monique, Moens, Hein J. Bernelot, Posthumus, Marcel D., Brus, Herman L. M., et al; Long-Term Remission in Daily Clinical Practice: Excellent 2 Year Results with Treatment To Target in Very Early Rheumatoid Arthritis, Results of the DREAM Remission Induction Cohort. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :662
DOI: 10.1002/art.28430

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