Predictors of remission in RA patients identified
medwireNews: Two studies have described factors associated with the achievement of sustained remission among patients with rheumatoid arthritis (RA).
In the first study, Nina Paulshus Sundlisæter (Diakonhjemmet Hospital, Oslo, Norway) and colleagues used data from the ARCTIC trial to identify predictors of treatment success among DMARD-naïve early RA patients who were treated according to a tight control algorithm with the aim of achieving remission. All patients received initial methotrexate alongside a tapering dose of prednisolone, followed by escalation to triple therapy and biologic DMARDs if the treatment target was not reached.
In all, 53% of 222 participants achieved sustained remission, defined as a Disease Activity Score at 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) below 1.6 points at 16-, 20- and 24-month follow-up visits.
Multivariate analysis demonstrated that patients with a higher degree of joint tenderness as measured by the Ritchie Articular Index at baseline had a lower probability of achieving sustained remission (odds ratio=0.90), and the results remained consistent when remission was defined according to ACR/EULAR Boolean remission criteria or a Simplified Disease Activity Index score of 3.3 points or lower.
Other factors, including higher BMI and rheumatoid factor positivity, were also identified as negative predictors of remission on univariate analysis, but the associations were not statistically significant on multivariate analysis.
These findings “demonstrate that despite an aggressive treatment approach, baseline factors associated with a lower chance of reaching remission are still present,” conclude the researchers in Rheumatology.
The second study, an analysis of a multicenter Japanese registry by Motomu Hashimoto (Kyoto University, Japan) and colleagues, investigated factors associated with sustained remission after discontinuation of biologic DMARDs.
As reported in Arthritis Research & Therapy, 21.5% of 181 RA patients who were in clinical remission (DAS28 based on C-reactive protein [DAS28-CRP] <2.3 points) at the time of biologic DMARD discontinuation were still in remission 1 year later.
The team found that patients who were in remission for more than 6 months before stopping biologic DMARD treatment were significantly more likely to maintain remission for 1 year than those who were in remission for less time, with a hazard ratio (HR) for remission failure of 0.50 on multivariate analysis.
Achieving Boolean remission at the time of biologic discontinuation was also a significant predictor of sustained remission (HR for remission failure=0.63), while glucocorticoid use at baseline was a negative predictor of sustained remission (HR for remission failure=1.50).
Hashimoto and team report that the type of biologic treatment may also influence the probability of achieving remission after discontinuation. Patients treated with monoclonal antibody tumor necrosis factor (TNF) inhibitors (infliximab, adalimumab, and golimumab) or anti-CTLA4 antibodies (abatacept) were significantly more likely to achieve biologic-free remission than those given other agents on univariate analysis, but these associations lost statistical significance on multivariate analysis.
The researchers conclude that taken together, these results suggest that “[a]lthough [biologic-free remission] is difficult to achieve in typical clinical practice, after strained and strict remission without glucocorticoid use, [biologic] DMARDs can be successfully withdrawn while retaining remission after discontinuation.”
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