medwireNews: Patients with early active rheumatoid arthritis (RA) who are treated with a target of remission may have better outcomes than those with a treatment target of low disease activity, researchers report.
“Treat-to-target therapy has been introduced in clinical trials and implemented in daily practice; however, the optimal treatment target is under discussion, and head-to-head comparisons are lacking,” say Gülşah Akdemir (Leiden University Medical Center, the Netherlands) and study co-authors.
The researchers compared 5-year outcomes among 133 patients who were treated with methotrexate, sulfasalazine, and prednisone with the aim of achieving low disease activity (Disease Activity Score [DAS]≤2.4 points) in the BeSt study, and 175 patients treated with methotrexate and prednisone to a target of DAS remission (<1.6 points) in the IMPROVED study.
They found that patients treated to a target of remission were significantly more likely to achieve DAS remission and drug-free DAS remission at the 5-year follow-up than those treated to a target of low disease activity, with corresponding rates of 43% versus 32% and 18% versus 8%.
These findings translated into a 4.5-fold higher likelihood of achieving drug-free DAS remission for patients receiving remission-targeted treatment after adjustment for factors including symptom duration, baseline disease activity, and time on treatment.
Therefore, “[a]iming at a target of DAS remission in patients with early active RA may be the preferred treatment target, which offers more patients the option to successfully taper and stop antirheumatic medication,” write the researchers in RMD Open.
Different treatment targets were not associated with changes in clinical and radiographic outcomes, however. DAS scores, tender and swollen joint counts, erythrocyte sedimentation rates, Sharp/van der Heijde scores, and patient-reported outcomes were comparable between the two groups at the 5-year follow-up.
Akdemir and colleagues explain that in order to maximize similarities between the two groups, only participants of the IMPROVED study who met the inclusion criteria for the BeSt study, and only those in BeSt who received comparable treatment to patients in IMPROVED, were included in the analysis.
However, they caution that “despite similarities between the patient groups, they are from two studies with differences in recruitment period, inclusion criteria, treatment strategies and therapies and evaluation frequencies, all of which may have influenced our outcomes beyond the effect of steering at different treatment targets.”
And the team concludes that although “DAS remission may be the better treatment target,” the feasibility and cost of remission-steered treatment should “be considered when deciding which is the optimal treatment target for each patient.”
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