title: Response to glucocorticoids at 2 weeks predicts the effectiveness of DMARD induction therapy at 3 months: post hoc analyses from the tREACH study.
abstract: OBJECTIVE
  To investigate if a glucocorticoid (GC) response at 2 weeks, defined by EULAR response criteria, can predict active disease (Disease Activity Score (DAS)>2.4) at 3 months.
  
  
  METHODS
  For this study, data of the Treatment in the Rotterdam Early Arthritis Cohort study (tREACH), an ongoing clinical trial that evaluates different induction therapies in early rheumatoid arthritis, were used. We selected patients who had a high probability of progressing to persistent arthritis (>70% based on the prediction model of Visser). All patients within the high-probability stratum, who had a baseline DAS>2.2 and a DAS assessment at 2 weeks after randomisation, were included (n=120). Besides GC response at 2 weeks, we investigated which other factors were associated with active disease (DAS>2.4) after 3 months of disease-modifying antirheumatic drug (DMARD) treatment. All variables with a p≤0.25 were assessed in our logistic regression model with backward selection. Variables were eliminated until all remaining variables had a significant association (p<0.05).
  
  
  RESULTS
  Patients who did not respond to GC bridging therapy at 2 weeks had an overall OR of having active disease at 3 months of 10.29 (95% CI 3.34 to 31.64; p<0.001) in comparison with responders. The corrected OR was 14.00 (95% CI 3.31 to 59.21; p<0.001). Our final model predicting response at 3 months included the following variables: gender, GC response, induction therapy arms and baseline DAS, which had an explained variance of 39%.
  
  
  CONCLUSIONS
  GC response at 2 weeks is a useful tool for recognising those patients who will probably have active disease (DAS>2.4) after 3 months of DMARD treatment.
authors.affiliation: Department of Rheumatology, University Medical Center, Rotterdam, Zuid-holland, The Netherlands. p.h.p.dejong@erasmusmc.nl
authors.forename: Pascal Hendrik Pieter
authors.initials: PH
authors.lastname: de Jong
authors.forename: Rogier A
authors.initials: RA
authors.lastname: Quax
authors.forename: Margriet
authors.initials: M
authors.lastname: Huisman
authors.forename: A H
authors.initials: AH
authors.lastname: Gerards
authors.forename: Richard A
authors.initials: RA
authors.lastname: Feelders
authors.forename: Peter B
authors.initials: PB
authors.lastname: de Sonnaville
authors.forename: Jolanda J
authors.initials: JJ
authors.lastname: Luime
authors.forename: Angelique E
authors.initials: AE
authors.lastname: Weel
authors.forename: J M
authors.initials: JM
authors.lastname: Hazes
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: Corticosteroids; Disease Activity; Early Rheumatoid Arthritis; Treatment