Long-Term Outcomes of Patients With Recent-Onset Rheumatoid Arthritis After 10 Years of Tight Controlled Treatment

Markusse, I.M.; Akdemir, G.; Dirven, Linda; Goekoop-Ruiterman, Yvonne P M; Groenendael, Johannes H L M van; Han, K.H.; Molenaar, T.H.E.; Cessie, Saskia le; Lems, Willem F.; Lubbe, Peter A H M van der; Kerstens, P.; Peeters, A.J.; Ronday, H.K.; Sonnaville, Peter B J de; Speyer, I.; Stijnen, Theo; Wolde, S. ten; Huizinga, Tom W J; Allaart, Cornelia F

doi:10.7326/m15-0919

Cited by 105 publications

(88 citation statements)

References 35 publications

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“…Better control of RA activity has recently been associated with fewer cardiovascular events [13]. Treat-to-target is the new gold standard for achieving RA control which has been shown to improve numerous outcomes [14] in randomized controlled trials [15–17]. “Abrogation of inflammation” by controlling RA, as emphasized in the 2014 treat-to-target update, improves CVD risk given the association between chronic inflammation and CVD [10].…”

Section: Introductionmentioning

confidence: 99%

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Chodara

Wattiaux²,

Bartels³

2017

Curr Rheumatol Rep

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The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. Purpose of Review By critically reviewing literature published within the past five years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. Recent Findings We examine recent guidelines, recommendations, and evidence, and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. Summary This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

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Section: Introductionmentioning

confidence: 99%

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Chodara

Wattiaux²,

Bartels³

2017

Curr Rheumatol Rep

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“…While evidence has continued to accumulate demonstrating that a T2T strategy in RA reduces morbidity and mortality, implementation in routine clinical practice remains challenging . There are many and varied barriers to the implementation of RA T2T and these may include funding models, waiting lists, public versus private pathways, cost of care including pharmaceuticals and patient factors including education level, health literacy, multifaceted adherence issues and rheumatology service access.…”

Section: Discussionmentioning

confidence: 99%

Treat‐to‐target in rheumatoid arthritis: Evaluating the patient perspective using the Patient Opinion Real‐Time Anonymous Liaison system: The RA T2T PORTAL study

et al. 2019

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Objectives:To determine the level of agreement among patients with rheumatoid arthritis (RA) with the principles and recommendations of the treat-to-target (T2T) initiative in New Zealand (NZ) and to further explore specific patient opinions via online iterative surveys. Methods: Participants with RA were recruited from rheumatology clinics in NZ and invited to receive and reply to surveys administered via the Patient Opinion Real-Time Anonymous Liaison (PORTAL) system. An enrolment survey recorded demographics, disease duration and treatment and then RA T2T surveys were administered weekly. A Likert scale 1-5 measured agreement with the principles and recommendations and further surveys explored responses of interest identified by investigators from each prior survey.Results: One hundred and ninety patients consented to participate in PORTAL and 132 in the RA T2T surveys. Level of agreement with RA T2T principles was: 93.3% to 99.3% and to the recommendations: 77.3%-100%. The lowest level of agreement 77.3% was with recommendation 8, 3 monthly treatment adjustment, and the highest was 100% agreement with recommendation 10, shared decision-making. Patients agreed less with low disease activity as the target compared with remission (91.4% and 98%). Despite high-level agreement for the use of a disease activity score (95.7%), 23% did not feel the individual components reflected their disease control. Patients rated difficulty coping, erosions on imaging, health-related quality of life and pain all significantly higher than C-reactive protein as indicators of worsening arthritis. Conclusions:Despite a high level of patient agreement with RA T2T this study highlights the importance of patient engagement in the RA T2T process to individualize therapy adjustments, make shared decisions and decide on targets that accurately reflect disease control according to patients. K E Y W O R D Srheumatoid arthritis, shared decision making, treat-to-target | 875 BENHAM Et Al.

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“…As expected, the results of the current trial are far superior. To our knowledge, studies with an active, modern treat‐to‐target strategy and long follow‐up times are sparse . The Dutch Behandel Strategieen (BeSt) trial compared 4 strategies guided by the DAS in 508 patients with early RA .…”

Section: Discussionmentioning

confidence: 99%

“…There are few trials using the modern treat‐to‐target approach with truly long‐term follow‐ups (at least 10 years), or comprehensive follow‐up coverage . Our previous analyses of the study TNF‐Blocking Therapy in Combination With Disease‐Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis (NEO‐RACo) have shown that in early RA, an intensified initial combination treatment strategy (Finnish Rheumatoid Arthritis Combination Therapy Trial [FIN‐RACo]) with methotrexate (MTX), sulfasalazine, hydroxychloroquine, and low‐dose 7.5‐mg prednisolone for 2 years, and free, active, remission‐targeted DMARD treatment thereafter, resulted in very low disease activity in most patients at 2 and 5 years.…”

Section: Introductionmentioning

confidence: 99%

Early Targeted Combination Treatment With Conventional Synthetic Disease‐Modifying Antirheumatic Drugs and Long‐Term Outcomes in Rheumatoid Arthritis: Ten‐Year Follow‐Up Results of a Randomized Clinical Trial

Rantalaiho

Sandström

Koski

et al. 2019

Arthritis Care & Research

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Objective. The short-term outcomes of remission-targeted treatments of rheumatoid arthritis (RA) are wellestablished, but the long-term success of such strategies is speculative, as is the role of early add-on biologics. We assessed the 10-year outcomes of patients with early RA treated with initial remission-targeted triple combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), 7.5-mg prednisolone, and additional infliximab (IFX) or placebo infusions.Methods. Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARDs and prednisolone and randomized to double-blind receipt of infusions of either IFX (the Finnish Rheumatoid Arthritis Combination Therapy Trial [FIN-RACo] + IFX) or placebo (FIN-RACo + placebo) during the first 6 months. After 2 years, the treatment strategies became unrestricted, but the treatment goal was strict remission in the TNF-Blocking Therapy in Combination With Disease-Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis (NEO-RACo) study. At 10 years, the clinical and radiographic outcomes and the drug treatments used between 5 and 10 years were assessed.Results. Ninety patients (91%) were followed after 2 years, 43 in the FIN-RACo + IFX and 47 in the FIN-RACo + placebo group. At 10 years, the respective proportions of patients in strict NEO-RACo remission and in Disease Activity Score using 28 joints remission in the FIN-RACo + IFX and FIN-RACo + placebo groups were 46% and 38% (P = 0.46) and 82% and 72% (P = 0.29), respectively. The mean total Sharp/van der Heijde score was 9.8 in the FIN-RACo + IFX and 7.3 in the FIN-RACo + placebo group (P = 0.34). During the 10-year follow-up, 26% of the FIN-RACo + IFX group and 30% of the FIN-RACo + placebo group had received biologics (P = 0.74).Conclusion. In early RA, excellent results can be maintained up until 10 years in most patients treated with initial combination csDMARDs and remission-targeted strategy, regardless of initial IFX/placebo infusions.

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Long-Term Outcomes of Patients With Recent-Onset Rheumatoid Arthritis After 10 Years of Tight Controlled Treatment

Abstract: Dutch College of Health Insurance Companies, Schering-Plough, and Janssen.

Cited by 105 publications

References 35 publications

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Treat‐to‐target in rheumatoid arthritis: Evaluating the patient perspective using the Patient Opinion Real‐Time Anonymous Liaison system: The RA T2T PORTAL study

Early Targeted Combination Treatment With Conventional Synthetic Disease‐Modifying Antirheumatic Drugs and Long‐Term Outcomes in Rheumatoid Arthritis: Ten‐Year Follow‐Up Results of a Randomized Clinical Trial

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