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Dear All,
Highlights of this issue are three important articles on outcomes in treating early RA in the biologic era. First article published in Annals of Internal medicine April 2016 issue (Long-Term Outcomes of Patients With Recent-Onset Rheumatoid Arthritis After 10 Years of Tight Controlled Treatment, Iris M. Markusse et al, Ann Intern Med. 2016; 164:523-531. doi: 10.7326/M15-0919) discusses much awaited 10 years outcome of BeSt study.
In this randomized, controlled trial 4 treat-to- target strategies were compared for early active RA over 10 years. Most patients had persistently reduced disease activity scores, improved functional status, and limited joint damage during follow-up. They had survival similar to that of the general Dutch population. Results of this trial give a realistic hope for drug-free remission, prevention of functional deterioration and radiographic damage, and normalized survival in most early RA patients by using treat to target strategy in routine clinical practice. Few drawbacks of this study have been the lack of a control arm with no treat to target strategy and high dropout rate (195 of 508 of patients – 38%). This will need to be answered in subsequent trials.
In the other two studies conventional synthetic DMARD combinations were compared with biologic combinations in early RA and 7 years work loss and cost effectiveness were assessed. In first of these two studies infliximab+methotrexate or conventional combination therapy were compared and authors did not find any difference in work loss days over 7 years (Infliximab versus Conventional Combination Treatment and 7-Year Work Loss in Early RA: Results of the Randomized Swefot Trial, Jonas K Eriksson et al, Arthritis Care & Research, ‘Accepted Article’, doi: 10.1002/acr.22899). In the second study that is the TEAR trial(Cost-Effectiveness of Triple Therapy versus Etanercept Plus Methotrexate in Early Aggressive Rheumatoid Arthritis. Hawre Jalal et al, Arthritis Care & Research, ‘Accepted Article’, doi: 10.1002/acr.22895)authors found that early triple combination therapy was the much more cost effective as compared to early etanercept (IE), step-up triple (ST), and step-up etanercept (SE) with similar results.
These pivotal trails are encouraging and leave us the message that early RA patients if treated aggressively by combination therapy and followed up by treat to target strategy help majority of patients live a normal life.
We welcome your suggestions to improve this IRA activity. Please post your suggestions/comments:
iraenewsletter@hotmail.com
Website: www.iraenewsletter.com
Regards,
Banwari Sharma
Editor, IRA e-Newsletter
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