From the Journals

Comparison shows tighter treat-to-target approach provides better outcomes in RA



Implementing a more stringent treat‐to‐target strategy could provide better outcomes for patients with early RA, according to a recent comparative study.

The findings confirm the feasibility of adopting a treat‐to‐target approach to ensure optimal outcomes are achieved for patients with early-stage disease.

“The objective of the present study was to compare achievement of remission during 2 years of follow-up in two early RA cohorts implementing different treat‐to‐target strategies,” wrote Vibeke Norvang, MD, of the department of rheumatology at Diakonhjemmet Hospital in Oslo, and colleagues. The findings were published in Arthritis & Rheumatology.

The researchers performed a pooled analysis of data from the randomized ARCTIC trial and the Norwegian Very Early Arthritis Clinic (NOR-VEAC) observational study. The combined cohort included a total of 429 disease-modifying antirheumatic drug (DMARD)–naive early RA patients, 189 and 330 from each study, respectively.

The American College of Rheumatology/European League Against Rheumatism Boolean remission criteria differed between the two cohorts, with more stringent criteria in ARCTIC than in NOR-VEAC. Remission was defined as scores of less than 1.6 and 2.6 on the Disease Activity Scores in 44 joints and 28 joints, respectively.

At 12- and 24-month follow-up, the researchers found that the odds of achieving remission were greater in ARCTIC than in NOR-VEAC (odds ratios, 1.97; 95% confidence interval, 1.21-3.20 vs. OR, 1.82; 95% CI, 1.05-3.16).

“We found that more than half of patients in each cohort had reached the study-specific remission targets at 6 months, and this increased to more than 60% in each cohort at 12 and 24 months,” they reported.

With respect to drug therapy, all study patients started with methotrexate monotherapy at a mean dose of 16.0 mg and 15.5 mg in ARCTIC and NOR-VEAC, respectively. In addition, similar rates of escalation to a biologic DMARD were observed in both studies (25.6% vs. 25.4%) at 24 months.

The researchers acknowledged that a key limitation of the study was comparing outcomes in two cohorts with different study designs; hence, the risk of bias in estimates of effect cannot be excluded.

“Targeting a more stringent remission and implementing more frequent visits provide further potential for favorable outcomes of a treat‐to‐target strategy,” they concluded.

The study was supported by legacy funds provided to the department of rheumatology at Diakonhjemmet Hospital. Three authors reported financial relationships with AbbVie, Amgen, Corrona, Genentech, Janssen, Mylan, Pfizer, and other companies.

SOURCE: Norvang V et al. Arthritis Rheumatol. 2020 Feb 23. doi: 10.1002/art.41232.

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