AI Article Synopsis
- The study aimed to compare the prevalence and predictors of sustained drug-free remission in two groups of recent-onset RA patients: those treated with DAS-driven therapy and those with non-DAS-driven therapy.
- After five years, the rates of sustained drug-free remission were similar between the two groups, although those on DAS-driven therapy had a higher remission rate among ACPA-positive patients.
- Independent predictors for sustained drug-free remission in both groups included the absence of ACPA and shorter symptom duration, suggesting that while DAS-driven therapy may benefit certain patients, overall outcomes were similar to non-DAS-driven treatments.
Article 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.
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| http://dx.doi.org/10.1093/rheumatology/ker516 | DOI Listing |
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