title: Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-alpha blockers: the GISEA study.
abstract: OBJECTIVE
  To assess the prevalence of good clinical response and remission in rheumatoid arthritis (RA) patients with longstanding disease treated with anti-tumor necrosis factor-alpha (TNF-alpha) drugs at outpatient clinics.
  
  
  METHODS
  Retrospective national study of 14 academic tertiary referral rheumatology medical centers. RA patients with a Disease Activity Score (DAS28) > 3.2 were defined as having active disease and could start TNF-alpha blockers. All patients received one TNF-alpha blocker plus methotrexate (10-20 mg/wk). At the third month the patients were categorized as responders or nonresponders, based on improvement of at least 0.25 of the Health Assessment Questionnaire (HAQ). Those who had improved by at least 0.25 HAQ were analyzed for possible predictors of DAS28 remission at the sixth month.
  
  
  RESULTS
  A total of 1257 patients started TNF-alpha blockers. Of these, 591 (46.7%) reached the sixth month with an improvement of HAQ of 0.25 at the third month. In the cohort of patients reaching HAQ of 0.25, DAS28 remission was seen in 24% of rheumatoid factor (RF)-positive and 36% of RF-negative patients (p = 0.03). Logistic regression analysis for predictors of remission identified age at baseline, HAQ < 1.63, and RF negativity as positive predictors of remission at 6 months along with sex (male).
  
  
  CONCLUSIONS
  We show that only a minority of patients with longstanding RA achieve a good clinical response or remission at the outpatient community level. Predictors of remission identify characteristics commonly observed in subsets with less severe RA.
authors.affiliation: Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Mancarella
authors.forename: Francesca
authors.initials: F
authors.lastname: Bobbio-Pallavicini
authors.forename: Fulvia
authors.initials: F
authors.lastname: Ceccarelli
authors.forename: Paola Chiara
authors.initials: PC
authors.lastname: Falappone
authors.forename: Angelo
authors.initials: A
authors.lastname: Ferrante
authors.forename: Domenico
authors.initials: D
authors.lastname: Malesci
authors.forename: Alfonso
authors.initials: A
authors.lastname: Massara
authors.forename: Francesca
authors.initials: F
authors.lastname: Nacci
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Secchi
authors.forename: Stefania
authors.initials: S
authors.lastname: Manganelli
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.forename: Maria Lisa
authors.initials: ML
authors.lastname: Bambara
authors.forename: Stefano
authors.initials: S
authors.lastname: Bombardieri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Gerli
authors.forename: Roberto
authors.initials: R
authors.lastname: Giacomelli
authors.forename: Walter
authors.initials: W
authors.lastname: Grassi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lapadula
authors.forename: Marco Matucci
authors.initials: MM
authors.lastname: Cerinic
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
authors.forename: Francesco
authors.initials: F
authors.lastname: Trotta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Triolo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Valentini
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
authors.forename: Gianfranco F
authors.initials: GF
authors.lastname: Ferraccioli
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D000069285:Infliximab; D007558:Italy; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011785:Quality Assurance, Health Care; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate