Early intervention could reduce RA risk
medwireNews: Results of a systematic review and meta-analysis suggest that very early therapeutic intervention could reduce the risk for disease onset among patients with pre-rheumatoid arthritis (RA).
Pre-RA – defined as undifferentiated arthritis (UA) or very early RA – is a clinical stage in which early intervention could be more efficacious than in later stages, Stephane Hilliquin (Pitié Salpêtrière University Hospital, Paris, France) told delegates at the Annual European Congress of Rheumatology (EULAR) 2017 in Madrid, Spain.
The researchers analyzed data from 1156 participants of nine randomized controlled trials investigating the efficacy of steroids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), or biologic DMARDs in preventing the appearance of RA.
Eight trials included participants with UA, while one involved patients with very early RA. Participants were aged a mean of 45.8 years, and the mean duration of symptoms was 16.2 weeks.
Overall, the team found that patients receiving active treatment were significantly less likely to receive a diagnosis of RA at week 52 than those in the control group, with a pooled odds ratio (OR) of 0.72. When the trials were analyzed by drug type, “all drugs except infliximab reduced the risk of RA,” said Hilliquin.
Indeed, in the two studies investigating the efficacy of infliximab, there was no significant difference in the rates of RA diagnosis at week 52 between participants receiving the tumor necrosis factor inhibitor and those in the control group (OR=9.55 and 1.38).
Despite the overall reduction in RA risk among patients receiving treatment, they were no more likely than controls to have no evidence of radiographic progression at week 52 (pooled OR=1.36).
The lack of effect of early treatment on disease progression was likely “due to the disease being at such an early stage,” said Hilliquin in a press release.
And he concluded that “our review of the available clinical data supports the rationale for early treatment” among patients with pre-RA.
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