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DMARD/corticosteroids prevented progression of ACPA-positive RA
Combination disease-modifying antirheumatic drugs and high-dose tapering corticosteroids prevented radiological progression in anti-citrullinated protein antibody-positive patients with early rheumatoid arthritis, according to recent study results.
Researchers in London analyzed data from the CARDERA control trial of 431 patients with early, active rheumatoid arthritis (RA; <2 years duration) who were randomly assigned methotrexate, methotrexate and ciclosporin, methotrexate and prednisolone or methotrexate, ciclosporin and prednisolone in a factorial-design. Three hundred ten patients (median age, 54 years; 67% women) were anti-citrullinated protein antibody (ACPA)-positive and 121 (median age, 55 years; 74% women) were ACPA-negative.
“To minimize multiple testing, we used a mixed-effects repeated measures ANOVA model to test for an interaction between ACPA and treatment on mean changes from baseline for each outcome (Larsen, disease activity score on a 28 joint count [DAS28], Health Assessment Questionnaire, EuroQol, SF-36 physical component summary [PCS] and mental component summary scores),” the researchers reported.
Researchers used t tests stratified by ACPA status to compare treatment groups at each time point for mean outcome changes when significant interactions occurred.
“ACPA status influenced the need for combinational treatments to reduce radiological progression,” the researchers reported.
Larsen score progression for all treatments showed significant reductions in ACPA-positive patients. Two-year mean Larsen score increases comprised 3.66 (95% CI, 2.27-5.05) with triple therapy and 9.58 (95% CI, 6.76-12.39) with monotherapy. New erosions with triple therapy treatment vs. monotherapy had an OR of 0.32 (95% CI, 0.14-0.72).
Minimal radiological progression was experienced by ACPA-negative patients in all treatment arms. DAS28/PCS scores improved with corticosteroid use only among ACPA-positive patients.
“Intensive combination therapy was only needed to prevent radiological progression in ACPA-positive patients,” the researchers concluded. “Additionally, corticosteroids only provided significant improvement in disease activity and physical health outcomes in ACPA-positive RA. These findings suggest that ACPA is an important biomarker for guiding treatment decisions in early RA.”
Disclosure: The researchers report no relevant financial disclosures.