Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study

Akdemir, G.; Heimans, L.; Bergstra, Sytske Anne; Goekoop, R.J.; Oosterhout, M. van; Groenendael, Johannes H L M van; Peeters, A.J.; Steup-Beekman, Gerda M; Lard, LR; Sonnaville, Peter B J de; Grillet, Bernard; Huizinga, Tom W J; Allaart, Cornelia F

doi:10.1136/annrheumdis-2017-211375

Cited by 65 publications

(55 citation statements)

References 34 publications

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“…In this regard, we have demonstrated that the maintenance of remission is possible in RA, especially in patients with RA who had received early treatment and in whom disease activity was well controlled before discontinuation of adalimumab (ADA), an anti-TNF agent [7,8]. However, little has been reported on the long-term outcome of biologics-free remission [9][10][11][12][13]. Since RA is a chronic disease, it is also important clinically to determine the long-term consequences of discontinuation of biologics.…”

Section: Introductionmentioning

confidence: 99%

5-year remission rate after the discontinuation of adalimumab in patients with rheumatoid arthritis: Long-term follow-up results of the HONOR study

Yamaguchi

Hirata

Kubo

et al. 2020

Modern Rheumatology

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Objectives: To determine the rate and factors associated with remission (disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) of <2.6) during a 5-year follow-up after the discontinuation of adalimumab (ADA) in patients with rheumatoid arthritis (RA). Methods: 75 patients who had been treated with ADA þ methotrexate (MTX) and maintained DAS28-ESR <2.6 for at least 6 months were enrolled. Among them, 52 patients discontinued ADA, and 46 patients completed a 5-year follow-up. Results: During the 5 years, 11 patients had DAS28-ESR <2.6. In 15 patients with DAS28-ESR <3.2, no significant changes were found in the health assessment questionnaire disability index (HAQ-DI) and modified total Sharp score (mTSS). When comparing patients with DAS28-ESR 1.61 versus 1.61 2 years). Among 31 patients who experienced flare, ADA was restarted in 24 patients, and 17 patients of these achieved DAS28-ESR <3.2 within 1-year. Conclusion: During the 5-year ADA-free period, remission rate was persistent in 21% of the patients. ADA-free remission was possible especially in patients with deeper remission (DAS28-ESR 1.61) and shorter disease duration (2 years).

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Section: Introductionmentioning

confidence: 99%

5-year remission rate after the discontinuation of adalimumab in patients with rheumatoid arthritis: Long-term follow-up results of the HONOR study

Yamaguchi

Hirata

Kubo

et al. 2020

Modern Rheumatology

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“…To date, there are several cohort studies reporting the rates of SR from 3% to 53%, mainly due to the different definitions of SR . Although some of them further explored the relevant prognostic factors, obvious inconsistencies exist in the effect of gender, serological antibodies, baseline disease activity, and initial treatment regimens .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Sustained remission (SR), rather than remission at a single time point, is more desirable due to its association with better RA prognosis, 5,6 reflected by quality of life, physical function, as well as radiographic progression. [7][8][9] To date, there are several cohort studies reporting the rates of SR from 3% to 53%, mainly due to the different definitions of SR. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Although some of them further explored the relevant prognostic factors, [13][14][15][16]18,19,[21][22][23][24] obvious inconsistencies exist in the effect of gender, 13,16,19 serological antibodies, 13,16,24 baseline disease activity, 13,19,21 and initial treatment regimens. 18 Moreover, participants in nearly all previous reports were exclusively diag...…”

Section: Introductionmentioning

confidence: 99%

Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Xie

Zhang

et al. 2019

Int J of Rheum Dis

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Aim To investigate the prevalence and predictors of sustained remission (SR) in an unselected Chinese rheumatoid arthritis (RA) population. Patients and methods Medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Clinical remission was defined according to Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28‐ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Boolean criteria. Remission persisting for at least 6 months was regarded as SR (6‐month SR). Kaplan‐Meier method and Cox regression analyses were performed to plot cumulative possibility of achieving 6‐month SR and to identify predictors. Results Seven hundred and seventy‐nine patients contributing 7958 clinic visits were included. During the follow‐up period, nearly half of patients achieved 6‐month SR according to DAS28‐ESR (51.6%), CDAI (45.6%), SDAI (44.0%), as well as Boolean definitions (42.4%). Median time periods to 6‐month SR were respectively 20.5, 28.7, 30.6, and 32.9 months based on the above criteria. Specifically, 29.4% to 41.2% of patients achieved 6‐month SR at least once in the first year of follow‐up, depending on instruments. Multivariate Cox regression indicated that increasing age, longer disease duration, higher baseline disease activity were independently correlated with reduced possibility of 6‐month SR assessed by nearly all definitions. Conversely, male, early RA, disease‐modifying antirheumatic drug‐naïve and lower disease activity scores in remission measured by corresponding criteria positively contributed to SR. Importantly, treat‐to‐target (T2T) adherence therapy and shorter time to remission were identified as stable determinants of SR across all definitions. Conclusions Achieving 6‐month SR was not uncommon in daily practice. Male, early RA, treatment‐naïve, T2T application, shorter time to remission, and lower disease activity scores in remission increased the occurrence of SR, while increasing age, longer disease duration, and higher baseline disease activity reduced the chance of remission sustainability.

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“…Nevertheless, Boolean remission remains hard to achieve, being observed in less than 20% of the patients in this study and in similar early arthritis cohorts (9). Such a low proportion does not seem to be significantly increased by the adoption of more aggressive strategies, such as earlier treatment initiation within the phase of undifferentiated arthritis and early combination with biological DMARDs, as in the IMPROVED study (32), or treatment to the target of imaging remission, such as in the ARCTIC trial (33).…”

Section: Discussionmentioning

confidence: 99%

Limiting factors to Boolean remission differ between autoantibody-positive and -negative patients in early rheumatoid arthritis

Bugatti

Stefano

Benaglio

et al. 2020

Preprint

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Background: Patients with established rheumatoid arthritis (RA) frequently miss Boolean remission solely because of the patient global assessment of disease activity (PGA) exceeding the cut-off of 1. Here, we investigated the frequency and the limiting variables to disease remission in patients with early RA treated with conventional synthetic disease modifying anti-rheumatic drugs according to a treat-to-target strategy, depending on the autoantibody status. Methods: Data were retrieved from 535 early RA patients (<12 months of symptoms), treatment-naïve at inclusion, with an observation period of 6 to 12 months upon initiation of therapy with methotrexate aimed at the achievement of low disease activity based on the 28-joints disease activity score. Near-remission was defined as any of the 4 core items of Boolean remission exceeding the cut-off of 1 with the remaining 3 all ≤1. Reasons for missing Boolean remission and predictors of near-remission subcategories were analysed in relation to baseline disease variables. Results: After 6 and 12 months from treatment start, near-remission was two-times more frequent than Boolean remission (25.6% and 26.9% at the two time-points). A 28-swollen joint count (SJC28) >1 was responsible for the majority of near-misses (56.2% and 57.6% at 6 and 12 months, respectively), and PGA >1 accounted for approximatively 35% of the cases. None of the variables of disease activity neither patient reported outcomes at baseline could discriminate SJC28 from PGA near-misses. Rather, autoantibody-positivity independently predicted the risk of missing remission because of SJC28 >1 with an adjusted OR [95% CI] of 3.62 [1.89-6.93] at 6 months and 2.36 [1.25-4.47] at 12 months, whilst autoantibody-negativity was an independent predictor of PGA near-miss (adjusted OR [95% CI] 2.71 [1.31-5.64] at 6 months and 6.50 [2.47-17.12] at 12 months). Conclusions: In patients with early RA, Boolean remission is more frequently missed because of persistent swollen joints. However, barriers to full-remission vary in relation to the autoantibody status. Autoantibody-positive patients more commonly experience residual swollen joints, whilst the PGA more frequently impairs the achievement of remission in autoantibody-negative patients. These findings indicate that efforts to target full-remission in early RA may require different treatment strategies according to the autoantibody profile.

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Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study

Cited by 65 publications

References 34 publications

5-year remission rate after the discontinuation of adalimumab in patients with rheumatoid arthritis: Long-term follow-up results of the HONOR study

5-year remission rate after the discontinuation of adalimumab in patients with rheumatoid arthritis: Long-term follow-up results of the HONOR study

Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Limiting factors to Boolean remission differ between autoantibody-positive and -negative patients in early rheumatoid arthritis

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