Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial.
OBJECTIVE
With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up.


METHODS
Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses.


RESULTS
During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification.


CONCLUSIONS
Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively.


BACKGROUND
ISRCTN26791028; Post-results.
Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.|Department of Rheumatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
T M
TM
Kuijper
Department of Rheumatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
J J
JJ
Luime
Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
P H P
PH
de Jong
Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands.
A H
AH
Gerards
Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
D
D
van Zeben
Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
I
I
Tchetverikov
Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands.|Reumazorg Zuid West Nederland, Goes, The Netherlands.
P B J
PB
de Sonnaville
Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands.|Reumazorg Zuid West Nederland, Vlissingen, The Netherlands.
M V
MV
van Krugten
Department of Rheumatology, Admiraal de Ruyter Hospital, Vlissingen, The Netherlands.|Department of Rheumatology, ZorgSaam Hospital, Terneuzen, The Netherlands.|Reumazorg Zuid West Nederland, Terneuzen, The Netherlands.
B A
BA
Grillet
Department of Rheumatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
J M W
JM
Hazes
Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.|Department of Rheumatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
A E A M
AE
Weel
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D012074:Remission Induction; D000067251:Symptom Flare Up; D013997:Time Factors
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate
DMARDs (biologic); DMARDs (synthetic); Disease Activity; Early Rheumatoid Arthritis; Treatment