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Combination therapy leads to better radiographic RA outcomes
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Initial combination therapy leads to better radiographic outcomes than step-up monotherapy among patients with early rheumatoid arthritis, according to findings published in BMC Rheumatology.
“This study is one of the first comparing the radiographic progression rates between two different treat-to-target strategies in real-life RA patients,” Laura M.M. Steunebrink, BSc, MSc, of the Arthritis Center Twente, in Enschede, the Netherlands, told Healio Rheumatology. “Overall, treat-to-target strategies resulted in very limited short-term radiographic progression.”
Steunebrink and colleagues evaluated if initial combination therapy results in better radiologic outcomes by analyzing data from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. The DREAM treat-to-target remission induction strategy 1 includes initial step-up monotherapy and was established in 2006. Strategy 2, established in 2012, involves initial combination therapy.
The researchers matched 128 patients who received strategy 2 with 128 who underwent strategy 1, based on age and disease activity at baseline. They then compared radiographic progression, and the number of patients who experienced a minimal clinically important difference between the strategies, using Mann Whitney U and chi-square tests. In addition, linear and logistic regression models examined which variables were associated with radiographic progression and clinically important differences within the first year.
According to the researchers, although patients who received early combination treatment reported slightly higher pain and disease activity scores at baseline, they also had better mental health scores. Patients who underwent early monotherapy experienced significantly more radiographic progression after 1 year, and experienced radiographic progression that was more frequently clinically relevant. Minimally clinically important differences were independently associated with fewer tender joints (P = .05) and higher erythrocyte sedimentation rate (P = .015) recorded at baseline.
“Patients following an initial combination therapy had even better outcome results after one year,” Steunebrink said. “A substantially larger number of patients within the combination therapy showed no radiographic progression at all and only a small portion of patients showed clinically relevant progression. Fewer painful joints and a higher erythrocyte sedimentation rate (ESR) at baseline turned out to be predictive of clinically relevant progression, independent of treatment strategy. Early and intensive treatment of RA is not only successful in decreasing disease activity but also in decreasing (irreversible) radiographic progression.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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