Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis

G. lşah Akdemir, Iris M. Markusse, Sytske Anne Bergstra, Robbert J. Goekoop, Esmeralda T. Molenaar, Johannes H. L. M. van Groenendael, Pit J. S. M. Kerstens, Willem F. Lems, Tom W. J. Huizinga, Cornelia F. Allaart

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives To compare outcomes of targeted treatment aimed at either low disease activity or remission in patients with early active rheumatoid arthritis (RA). Methods Five-year outcomes were compared in 133 patients with early active RA (1987), starting with methotrexate, sulfasalazine and tapered high dose of prednisone (arm 3 of the BehandelStrategieën (Treatment Strategies for Rheumatoid Arthritis) (BeSt) study), targeted at Disease Activity Score (DAS) ≤2.4 (low disease activity), and 175 patients with early RA, starting methotrexate and tapered high dose of prednisone, targeted at DAS <1.6 (selected from IMPROVED study who would have fulfilled inclusion criteria of the BeSt study). Association of treatment target with outcomes DAS <1.6, Boolean remission at year 1 and drug-free DAS remission (DFR) at year 5 were analysed by logistic regression analysis. Results At baseline, DAS <1.6 steered patients had a milder disease than DAS ≤2.4 steered patients (mean DAS 4.1±SD 0.7vs4.4±0.9, p=0.012) and less radiological damage. DAS decrease, functional ability and radiological damage progression over time were similar in both patient groups. DAS ≤2.4 was achieved in similar percentages in both patient groups, but more DAS <1.6 steered patients achieved DAS <1.6 and DFR. DAS <1.6 steered treatment was associated with achieving DAS <1.6 (OR 3.04 (95% CI 1.64 to 5.62)) and Boolean remission (3.03 (1.45 to 6.33)) at year 1 and DFR at year 5 (3.77 (1.51 to 9.43)). Conclusions In patients with early active RA who start with comparable disease-modifying antirheumatic drug+prednisone combination therapy, subsequent DAS <1.6 steered treatment is associated with similar clinical and radiological outcomes over time as DAS ≤2.4 steered treatment; however, in the DAS <1.6 steered group, more patients achieved remission and drug-free remission.
Original languageEnglish
Article numbere000649
JournalRMD Open
Volume4
Issue number1
DOIs
Publication statusPublished - 2018

Cite this

Akdemir, G. L., Markusse, I. M., Bergstra, S. A., Goekoop, R. J., Molenaar, E. T., van Groenendael, J. H. L. M., ... Allaart, C. F. (2018). Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis. RMD Open, 4(1), [e000649]. https://doi.org/10.1136/rmdopen-2018-000649
Akdemir, G. lşah ; Markusse, Iris M. ; Bergstra, Sytske Anne ; Goekoop, Robbert J. ; Molenaar, Esmeralda T. ; van Groenendael, Johannes H. L. M. ; Kerstens, Pit J. S. M. ; Lems, Willem F. ; Huizinga, Tom W. J. ; Allaart, Cornelia F. / Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis. In: RMD Open. 2018 ; Vol. 4, No. 1.
@article{00012cb51f1d4b299e1e32fb7ec9e160,
title = "Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis",
abstract = "Objectives To compare outcomes of targeted treatment aimed at either low disease activity or remission in patients with early active rheumatoid arthritis (RA). Methods Five-year outcomes were compared in 133 patients with early active RA (1987), starting with methotrexate, sulfasalazine and tapered high dose of prednisone (arm 3 of the BehandelStrategie{\"e}n (Treatment Strategies for Rheumatoid Arthritis) (BeSt) study), targeted at Disease Activity Score (DAS) ≤2.4 (low disease activity), and 175 patients with early RA, starting methotrexate and tapered high dose of prednisone, targeted at DAS <1.6 (selected from IMPROVED study who would have fulfilled inclusion criteria of the BeSt study). Association of treatment target with outcomes DAS <1.6, Boolean remission at year 1 and drug-free DAS remission (DFR) at year 5 were analysed by logistic regression analysis. Results At baseline, DAS <1.6 steered patients had a milder disease than DAS ≤2.4 steered patients (mean DAS 4.1±SD 0.7vs4.4±0.9, p=0.012) and less radiological damage. DAS decrease, functional ability and radiological damage progression over time were similar in both patient groups. DAS ≤2.4 was achieved in similar percentages in both patient groups, but more DAS <1.6 steered patients achieved DAS <1.6 and DFR. DAS <1.6 steered treatment was associated with achieving DAS <1.6 (OR 3.04 (95{\%} CI 1.64 to 5.62)) and Boolean remission (3.03 (1.45 to 6.33)) at year 1 and DFR at year 5 (3.77 (1.51 to 9.43)). Conclusions In patients with early active RA who start with comparable disease-modifying antirheumatic drug+prednisone combination therapy, subsequent DAS <1.6 steered treatment is associated with similar clinical and radiological outcomes over time as DAS ≤2.4 steered treatment; however, in the DAS <1.6 steered group, more patients achieved remission and drug-free remission.",
author = "Akdemir, {G. lşah} and Markusse, {Iris M.} and Bergstra, {Sytske Anne} and Goekoop, {Robbert J.} and Molenaar, {Esmeralda T.} and {van Groenendael}, {Johannes H. L. M.} and Kerstens, {Pit J. S. M.} and Lems, {Willem F.} and Huizinga, {Tom W. J.} and Allaart, {Cornelia F.}",
year = "2018",
doi = "10.1136/rmdopen-2018-000649",
language = "English",
volume = "4",
journal = "RMD Open",
issn = "2056-5933",
publisher = "BMJ Publishing Group",
number = "1",

}

Akdemir, GL, Markusse, IM, Bergstra, SA, Goekoop, RJ, Molenaar, ET, van Groenendael, JHLM, Kerstens, PJSM, Lems, WF, Huizinga, TWJ & Allaart, CF 2018, 'Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis' RMD Open, vol. 4, no. 1, e000649. https://doi.org/10.1136/rmdopen-2018-000649

Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis. / Akdemir, G. lşah; Markusse, Iris M.; Bergstra, Sytske Anne; Goekoop, Robbert J.; Molenaar, Esmeralda T.; van Groenendael, Johannes H. L. M.; Kerstens, Pit J. S. M.; Lems, Willem F.; Huizinga, Tom W. J.; Allaart, Cornelia F.

In: RMD Open, Vol. 4, No. 1, e000649, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Comparison between low disease activity or das remission as treatment target in patients with early active rheumatoid arthritis

AU - Akdemir, G. lşah

AU - Markusse, Iris M.

AU - Bergstra, Sytske Anne

AU - Goekoop, Robbert J.

AU - Molenaar, Esmeralda T.

AU - van Groenendael, Johannes H. L. M.

AU - Kerstens, Pit J. S. M.

AU - Lems, Willem F.

AU - Huizinga, Tom W. J.

AU - Allaart, Cornelia F.

PY - 2018

Y1 - 2018

N2 - Objectives To compare outcomes of targeted treatment aimed at either low disease activity or remission in patients with early active rheumatoid arthritis (RA). Methods Five-year outcomes were compared in 133 patients with early active RA (1987), starting with methotrexate, sulfasalazine and tapered high dose of prednisone (arm 3 of the BehandelStrategieën (Treatment Strategies for Rheumatoid Arthritis) (BeSt) study), targeted at Disease Activity Score (DAS) ≤2.4 (low disease activity), and 175 patients with early RA, starting methotrexate and tapered high dose of prednisone, targeted at DAS <1.6 (selected from IMPROVED study who would have fulfilled inclusion criteria of the BeSt study). Association of treatment target with outcomes DAS <1.6, Boolean remission at year 1 and drug-free DAS remission (DFR) at year 5 were analysed by logistic regression analysis. Results At baseline, DAS <1.6 steered patients had a milder disease than DAS ≤2.4 steered patients (mean DAS 4.1±SD 0.7vs4.4±0.9, p=0.012) and less radiological damage. DAS decrease, functional ability and radiological damage progression over time were similar in both patient groups. DAS ≤2.4 was achieved in similar percentages in both patient groups, but more DAS <1.6 steered patients achieved DAS <1.6 and DFR. DAS <1.6 steered treatment was associated with achieving DAS <1.6 (OR 3.04 (95% CI 1.64 to 5.62)) and Boolean remission (3.03 (1.45 to 6.33)) at year 1 and DFR at year 5 (3.77 (1.51 to 9.43)). Conclusions In patients with early active RA who start with comparable disease-modifying antirheumatic drug+prednisone combination therapy, subsequent DAS <1.6 steered treatment is associated with similar clinical and radiological outcomes over time as DAS ≤2.4 steered treatment; however, in the DAS <1.6 steered group, more patients achieved remission and drug-free remission.

AB - Objectives To compare outcomes of targeted treatment aimed at either low disease activity or remission in patients with early active rheumatoid arthritis (RA). Methods Five-year outcomes were compared in 133 patients with early active RA (1987), starting with methotrexate, sulfasalazine and tapered high dose of prednisone (arm 3 of the BehandelStrategieën (Treatment Strategies for Rheumatoid Arthritis) (BeSt) study), targeted at Disease Activity Score (DAS) ≤2.4 (low disease activity), and 175 patients with early RA, starting methotrexate and tapered high dose of prednisone, targeted at DAS <1.6 (selected from IMPROVED study who would have fulfilled inclusion criteria of the BeSt study). Association of treatment target with outcomes DAS <1.6, Boolean remission at year 1 and drug-free DAS remission (DFR) at year 5 were analysed by logistic regression analysis. Results At baseline, DAS <1.6 steered patients had a milder disease than DAS ≤2.4 steered patients (mean DAS 4.1±SD 0.7vs4.4±0.9, p=0.012) and less radiological damage. DAS decrease, functional ability and radiological damage progression over time were similar in both patient groups. DAS ≤2.4 was achieved in similar percentages in both patient groups, but more DAS <1.6 steered patients achieved DAS <1.6 and DFR. DAS <1.6 steered treatment was associated with achieving DAS <1.6 (OR 3.04 (95% CI 1.64 to 5.62)) and Boolean remission (3.03 (1.45 to 6.33)) at year 1 and DFR at year 5 (3.77 (1.51 to 9.43)). Conclusions In patients with early active RA who start with comparable disease-modifying antirheumatic drug+prednisone combination therapy, subsequent DAS <1.6 steered treatment is associated with similar clinical and radiological outcomes over time as DAS ≤2.4 steered treatment; however, in the DAS <1.6 steered group, more patients achieved remission and drug-free remission.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29862045

U2 - 10.1136/rmdopen-2018-000649

DO - 10.1136/rmdopen-2018-000649

M3 - Article

VL - 4

JO - RMD Open

JF - RMD Open

SN - 2056-5933

IS - 1

M1 - e000649

ER -