Intensive treatment in early arthritis patients provides long-term remission benefits
medwireNews: Short-term induction therapy with a tumor necrosis factor (TNF) inhibitor plus methotrexate could alter disease development in some patients with early rheumatoid arthritis (RA), providing long-term benefit, results of the DINORA trial suggest.
This “provides important new information on the validity of the window of opportunity hypothesis,” say the study authors.
They found that, after 1 year, 32% of 38 patients with early RA or undifferentiated arthritis who were randomly assigned to receive infliximab plus methotrexate had achieved sustained remission. This was defined as having no swollen joints, no more than two tender joints, and a normal C-reactive protein level or erythrocyte sedimentation rate at two consecutive visits 8 weeks apart.
This rate of clinical remission was higher compared with 14% of 36 early RA patients randomly assigned to receive methotrexate alone and 0% of 16 patients receiving placebo.
The only significant treatment difference in clinical remission rate was between patients receiving combination treatment and those taking placebo, but Josef Smolen (Medical University of Vienna, Austria) and DINORA (Definitive Intervention in New Onset Rheumatoid Arthritis) co-researchers believe that the “trend was clear” for a beneficial effect of combination treatment over methotrexate alone, with “more than twice as many stringently defined remissions.”
They also point out in Arthritis Research & Therapy that 75% of the patients who achieved clinical remission with infliximab plus methotrexate at 1 year were still in remission during the second year, when all treatment had been stopped, whereas this was the case for just 20% of patients taking methotrexate alone, giving overall remission rates at 2 years of 24% versus 3%.
“Together, these findings suggest that once joint inflammation is clinically manifest, symptomatic therapy does not impact on the course of disease, that initiation of DMARD therapy is warranted to improve outcomes, and that early intensive treatment with anti-TNF [plus methotrexate] leads to drug-free remission in 1 in 4 patients,” say Smolen and colleagues.
And sustained drug-free remission did not appear to depend on a long duration of induction treatment, says the team who found that 26% of patients treated with infliximab plus methotrexate had achieved sustained clinical remission by week 30, all of whom were still in remission at the end of the year.
Neither of the active therapies appeared to cause major serious adverse events and only four of all reported adverse events were considered related to the study drug, the researchers report.
They conclude: “While the current study involves only TNF as a target of biological therapy, the data nevertheless strongly support the possibility that patients with early inflammatory arthritis may have a window of opportunity in which disease reversal is possible.”
By Lucy Piper
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