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High remission rate seen with treat-to-target strategy for patients with RA

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SAN FRANCISCO — Recently presented data showed a treat-to-target strategy yielded a high rate of remission in a prospective cohort study of patients with rheumatoid arthritis who were based in 10 countries.

The researchers included 2-year data from the BIODAM study of patients with rheumatoid arthritis (RA) who were started on or changed disease-modifying anti-rheumatic drugs (DMARDs) and/or anti-tumor necrosis factor (anti-TNF) and followed every 3 months. Physicians involved in the study agreed to practice a treat-to-target protocol to meet a Disease Activity Score based on 28 joints and C-reactive protein (DAS28-CRP) of 2.6 or less, intensification of treatment by dosage or added therapeutics in the presence of DAS28-CRP above 2.6 for remission, or low disease activity (LDA) of a DAS28-CRP of up to 3.2.

“Treating toward remission is one of the main aims in the treatment of patients with RA,” Sofia Ramiro, MD, PhD, of Leiden University Medical Center in Leiden, the Netherlands, said. “We have evidence that remission is the best outcome for patients, and therefore, the treat-to-target strategy is recommended. However, until now, we did not have any study assessing the impact of following treat-to-target strategy on disease activity outcomes over time. Because patients were followed up over time, BIODAM provided an optimal setting to test this strategy.”

Ramiro and colleagues analyzed the results from 3,084 visits by 539 patients with a mean age of 56 years. Patients had a disease duration of 6 years. Overall, 49% of patients were DMARD-naïve and 76% were women. The treat-to-target remission strategy was employed in 68% of the visits, and a treat-to-target LDA strategy was employed in 79% of visits. Remission based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission was achieved by 15% of the visits, DAS28-CRP remission was met in 39%, DAS28-LDA was met by 53% of visits, Clinical Disease Activity Index (CDAI) remission was apparent in 16% and the Simplified Disease Activity Index (SDAI) remission was met by 18% of visits.

Analysis showed a 52% greater likelihood of ACR/EULAR Boolean remission after 3 months of treatment was present with a treat-to-target remission strategy compared with other care. A reduction of disease activity was seen following both treat-to-target remission and LDA strategies with all measures except DAS28-CRP. The effect of treat-to-target remission was greater in patients with no prior history of DMARD use with an odds ratio of 2.10 compared to patients with a prior history of DMARD use. - by Shirley Pulawski

Reference:

Ramiro S, et al. Paper #3184. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.

Disclosures: Ramiro reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.