What have we learned from BeSt?

Cornelia F Allaart, Iris M Markusse, Willem F Lems

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: How have the long term outcomes of RA improved in the last decade?

METHODS: Patients with DMARD naïve RA were randomized to 4 treatment strategies: 1. sequential DMARD monotherapy, 2. step-up combination therapy, 3. initial combination therapy including prednisone or 4. including infliximab. Treatment-to-target was aimed at DAS≤2.4 (three-monthly calculations). Functional ability (HAQ), radiologic damage progression (Sharp/vanderHeijde Score) and overall survival were reported.

RESULTS: Patients in arms 3 and 4 showed earlier clinical improvement. Up to 50% achieved DAS-remission (<1.6), up to 29% achieved drug free remission. Damage progression was well suppressed (median after 10years in completers 2 SHS points), functional ability approached normality (mean HAQ 0.6). There was no increased mortality (Standardized Mortality Ratio 1.16, 95% CI 0.92-1.46).

CONCLUSIONS: Early treatment determines early clinical improvement, treatment-to-target determines long term outcomes. Prevention of relevant radiologic damage progression and disability, drug free remission and normalized survival are realistic goals.

Original languageEnglish
Pages (from-to)74-78
Number of pages5
JournalClinical Immunology
Early online date18 Sep 2017
Publication statusPublished - 1 Jan 2018

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