Getting to Remission - Without Biologics Save

Analysis of data from two early rheumatoid arthritis (ERA) cohorts shows remission in RA is primarily seen in those who do not require biologic DMARDs (bDMARDs), while those needing bDMARDs are less apt to achieve remission. 

 

Remission in RA varies according to he study, cohort, disease duration, etc., and ranges from 20% to 50% in some series. These investigators hypothesized that patients requiring biological DMARDs represent a subgroup that is less capable of reaching sustained DMARD-free remission compared with patients not requiring a biological DMARD.

 

Data was drawn from from two prospective ERA populations (Leiden Early Arthritis Clinic [EAC], Rotterdam Early Arthritis Cohort [tREACH)]. The primary outcome was sustained DMARD-free remission, which was defined as absence of clinical synovitis after discontinuation of DMARDs for at least 1 year. Patients not receiving bDMARDs in 5 years (EAC) or 3 years (tREACH) were compared.

 

From a total of 627 ERA patients in the EAC (62% female; mean 60 years), 14% received a bDMARD and 86% had never used a bDMARD. Sustained DMARD-free remission at 5 years was seen: 

 

From a total of 425 ERA patients (67% female; mean 54 years) there were 36% who received bDMARD and 64% who had never used a bDMARD.

Sustained DMARD-free remission at 3 years was seen:

 

Those likely to achieve sustained DMARD-free remission are those RA patients who do not require bDMARDs. Whether these findings impact EULAR recommendations on continuing or stopping DMARDs, if in remission, remains to be seen.