Remission Becoming a Reachable Goal in RA : Strategies now include intensive management, treatment to target, and combined DMARDs.

The final strategy – remission induction – remains largely uncharacterized, he said, noting that there are few good studies, and more definitive research is needed to clarify its role.

“By and large we need to maintain the therapies we've started that get our patients into remission, and by and large we cannot plan to withdraw therapies large scale. … There's little compelling evidence, as far as I can see, of early aggressive therapy of any form that can substantially and permanently modify disease processes such that therapy can be withdrawn,” Dr. Porter said.

That suggests rheumatologists are doing much better than 20 years ago in terms of climbing the RA therapy mountain but that the summit has not been reached. And if the RA therapy goals of drug-free remission, cure, and prevention are added to that mountain – which currently has symptom control at its base, followed by disease modification and remission, then half of the mountain remains to be conquered.

In conclusion, Dr. Porter quoted a recent editorial that accompanied another DMARD combination trial (Lancet 2009;374:430-2):

“The most important information to be gathered from clinical trials in RA is not necessarily comparison of agents, but rather the strategy of tight control aiming for remission.”

Dr. Porter said that he has received research funding, served as a consultant, and/or served on the speakers bureau for Abbott, Pfizer, Roche, Schering Plough, and UCB.