Sustained drug-free remission in rheumatoid arthritis after DAS-driven or non-DAS-driven therapy: a comparison of two cohort studies.

Abstract

OBJECTIVES:

To compare the prevalence of and predictors for sustained drug-free remission in two cohorts of patients with recent-onset RA treated with DAS-driven therapy or non-DAS-driven therapy.

METHODS:

Sustained drug-free remission was assessed after 5 years of follow-up in 508 patients treated with DAS-driven therapy (DAS ≤ 2.4) in a randomized treatment cohort, and in 424 patients who received non-DAS-driven therapy in a prospective inception cohort. The design of the DAS-driven cohort required systematic joint assessments with DAS-driven restart of therapy. Predictors for remission were identified by univariable and multivariable logistic regression in each cohort separately and in a combined multivariate logistic regression analysis corrected for propensity scores, including a sensitivity analysis on patients receiving initial monotherapy.

RESULTS:

Patients in the DAS-driven cohort had more active disease at baseline, but the prevalence of sustained drug-free remission was similar after DAS-driven (9.8%) and non-DAS-driven therapy (10.6%). Among patients with ACPA, drug-free remission was more frequently achieved after DAS-driven than after non-DAS-driven therapy (5.4 vs. 2.1%, OR = 2.68, 95% CI 0.97, 7.43). Absence of ACPA and short symptom duration were independent predictors for sustained drug-free remission in both cohorts. Initial treatment choice and inclusion period were not predictive. The sensitivity analysis yielded comparable results.

CONCLUSION:

Retrospectively comparing a DAS-driven to a non-DAS-driven therapy cohort, the occurrence and predictors of sustained drug-free remission were similar. The DAS-driven cohort had a more unfavourable prognosis. DAS-driven therapy may improve the chance of sustained drug-free remission in ACPA-positive patients with recent-onset RA.

• Authors: Diane van der Woude, Karen Visser, Naomi B Klarenbeek, H Karel Ronday, André J Peeters, Pit J S M Kerstens, Ben A C Dijkmans, Tom W J Huizinga, Annette H M van der Helm-van Mil, Cornelia F Allaart
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 51 Issue 6 Pg. 1120-8 (Jun 2012) ISSN: 1462-0332 [Electronic] England
• PMID: 22337939 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Tumor Necrosis Factor-alpha

Topics

• Adolescent
• Adult
• Aged
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, epidemiology, pathology)
• Cohort Studies
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Humans
• Joints (pathology)
• Logistic Models
• Male
• Multivariate Analysis
• Predictive Value of Tests
• Prevalence
• Randomized Controlled Trials as Topic
• Remission Induction
• Retrospective Studies
• Sensitivity and Specificity
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)