Afully sustained, disease-modifying-antirheumatic-drug-free remission occurred in 15% of patients using conventional, nonbiologic therapy, according to results from a large 10-year study.
“We were surprised by the high number of patients who achieved remission,” Dr. Diane van der Woude of Leiden University Medical Centre (Netherlands), and the study's lead author, said in an interview. The data was reported at the annual European Congress of Rheumatology. “The patients we studied were enrolled between 1993 and 2003, a time when there were no biological agents available and disease activity was not strictly monitored. That 15% of patients treated with conventional therapy achieved remission is a useful number to keep in mind as a reference when reading reports of remission percentages after treatment with novel agents.”
She looked at 454 RA patients. Patients were treated with a delayed or early treatment strategy with chloroquine, sulfasalazine, or methotrexate. They defined DMARD-free remission as absence of synovitis without concomitant use of disease-modifying antirheumatic drugs (DMARDs) for more than 1 year. Average follow-up was 8 years. Of the 454 RA patients, 69 (15%) achieved DMARD-free remission.
Univariate analysis revealed that the following were significantly associated with achieving DMARD-free remission: negative family history (hazard ratio of 1.8), short duration of complaints before presentation (HR 1.08 per month), nonsmoking (HR 1.8), low C-reactive protein at baseline (HR 1.01 per mg/L), absence of IgM rheumatoid factor and anti-CCP antibodies (HR 5.9 and 11.6, respectively), and absence of HLA shared epitope alleles (HR 2.1).
Multivariate analysis revealed that low C-reactive protein at baseline and absence of anti-CCP antibodies were significant independent predictors for DMARD-free remission.
“We are currently working on replication of these data in another large [non-Dutch] early arthritis cohort, also consisting of patients treated with conventional antirheumatic therapy,” Dr. van der Woude said in an interview. “It will be interesting to see if we and our collaborators will find a similar prevalence of DMARD-free remission and similar predictive characteristics,” she added.