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.


In Early RA, Patients with a Good Initial Response to MTX Monotherapy Have Excellent Clinical Outcomes over Two Years of Therapy, but Radiological Progression Is Not Completely Prevented.

Wallin4,  Helena, Van Vollenhoven2,  Ronald, Ernestam Ingemar F. Petersson3,  Kristina Albertsson, Kristina Forslind, Sofia, Rezaei Johan Bratt1,  Pierre Geborek, Hamed

Karolinska Univ Hosp Huddinge, Stockholm, Sweden
Karolinska University Hospital, Stockholm, Sweden
Lund University Hosp, Lund, Sweden
The Karolinska Institute, Stockholm, Sweden

Background:

In the SWEFOT trial, all patients were initially given MTX monotherapy for 3–4 months; patients achieving a DAS28<=3.2 were not randomized in the controlled portion of the trial. We previously demonstrated that this was the case for 30% of the patients, most of whom maintained remission during the first year. Here, we investigated the clinical and radiological results in these patients over two years of follow-up.

Objectives:

To analyze the clinical and radiological course in patients from the SWEFOT study who responded adequately to initial MTX monotherapy and were not included in the randomized trial.

Methods:

A total of 487 patients with early RA (symptom duration <1 year) were started on MTX at a rapidly escalating dosage up to at least 20 mg/week. After 3–4 months, the 147 patients who had a DAS28<=3.2 were not randomized but continued on MTX and were followed in "regular care", including 3-monthly assessments. These patients were analyzed here. Complete data at 24 months were available for 65% of patients.

Results:

The majority of patients continued on MTX monotherapy. In 15 patients MTX was replaced by or complemented with another DMARD or a biologic. DAS28 values in all patients are shown in the figure, and demonstrate low values throughout. At the 6, 12, 18 and 24 months time-points, 61.1%, 61.0%, 64.2%, and 72.7% of patients, respectively, were in DAS28 remission, and 82.1 – 87.6% had a low disease activity state.

The mean (SEM) progression in total Sharp-vdHeijde score at 24 months was 3.90 (0.68). For the subset of patients who had been in sustained remission at each time point from 3 to 24 months (n=18) the progression was 4.06 (1.85). Progression in patients on MTX monotherapy throughout follow-up was 3.97 (0.85).

Conclusion:

Patients who respond to an initial 3–4 month trial of MTX monotherapy with a DAS28<=3.2 continue to have very good clinical responses for two years, and additional treatment is needed infrequently. However, radiographic progression does occur and is seen even in those patients who have sustained remission and/or stay on MTX monotherapy. An initial good response to MTX appears to portend a good clinical prognosis but close monitoring of radiological disease is warranted.

To cite this abstract, please use the following information:
Wallin, Helena, Van Vollenhoven, Ronald, Ernestam Ingemar F. Petersson, Kristina Albertsson, Kristina Forslind, Sofia, Rezaei Johan Bratt, Pierre Geborek, Hamed; In Early RA, Patients with a Good Initial Response to MTX Monotherapy Have Excellent Clinical Outcomes over Two Years of Therapy, but Radiological Progression Is Not Completely Prevented. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1393
DOI: 10.1002/art.29159

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