Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial

T M Kuijper; J J Luime; P H P de Jong; A H Gerards; D van Zeben; I Tchetverikov; P B J de Sonnaville; M V van Krugten; B A Grillet; J M W Hazes; A E A M Weel

doi:10.1136/annrheumdis-2016-209272

Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial

T M Kuijper^*, J J Luime, P H P de Jong, A H Gerards, D van Zeben, I Tchetverikov, P B J de Sonnaville, M V van Krugten, B A Grillet, J M W Hazes, A E A M Weel

^*Corresponding author for this work

Rheumatology

Research output: Contribution to journal › Article › Academic › peer-review

36 Citations (Scopus)

Abstract

OBJECTIVES: With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up.

METHODS: Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses.

RESULTS: During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification.

CONCLUSIONS: Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively.

TRIAL REGISTRATION NUMBER: ISRCTN26791028; Post-results.

Original language	English
Pages (from-to)	2119-2123
Number of pages	5
Journal	Annals of the Rheumatic Diseases
Volume	75
Issue number	12
DOIs	https://doi.org/10.1136/annrheumdis-2016-209272
Publication status	Published - Dec 2016

Bibliographical note

Funding:
This work was supported by an unrestrictive grant from Pfizer B.V.
[0881-102217]. Pfizer had no involvement in the study design; in collection,
analysis and interpretation of data; writing of the report, and decision to submit for
publication. The corresponding author had full access to all data and had final
responsibility for the decision to submit for publication. Data management was
sponsored by the Dutch Arthritis Foundation.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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10.1136/annrheumdis-2016-209272

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Kuijper, T. M., Luime, J. J., de Jong, P. H. P., Gerards, A. H., van Zeben, D., Tchetverikov, I., de Sonnaville, P. B. J., van Krugten, M. V., Grillet, B. A., Hazes, J. M. W., & Weel, A. E. A. M. (2016). Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial. Annals of the Rheumatic Diseases, 75(12), 2119-2123. https://doi.org/10.1136/annrheumdis-2016-209272

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title = "Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial",

abstract = "OBJECTIVES: With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up.METHODS: Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses.RESULTS: During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification.CONCLUSIONS: Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively.TRIAL REGISTRATION NUMBER: ISRCTN26791028; Post-results.",

author = "Kuijper, {T M} and Luime, {J J} and {de Jong}, {P H P} and Gerards, {A H} and {van Zeben}, D and I Tchetverikov and {de Sonnaville}, {P B J} and {van Krugten}, {M V} and Grillet, {B A} and Hazes, {J M W} and Weel, {A E A M}",

note = "Funding: This work was supported by an unrestrictive grant from Pfizer B.V. [0881-102217]. Pfizer had no involvement in the study design; in collection, analysis and interpretation of data; writing of the report, and decision to submit for publication. The corresponding author had full access to all data and had final responsibility for the decision to submit for publication. Data management was sponsored by the Dutch Arthritis Foundation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.",

year = "2016",

month = dec,

doi = "10.1136/annrheumdis-2016-209272",

language = "English",

volume = "75",

pages = "2119--2123",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "Elsevier",

number = "12",

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Kuijper, TM, Luime, JJ , de Jong, PHP, Gerards, AH, van Zeben, D, Tchetverikov, I, de Sonnaville, PBJ, van Krugten, MV, Grillet, BA, Hazes, JMW & Weel, AEAM 2016, 'Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial', Annals of the Rheumatic Diseases, vol. 75, no. 12, pp. 2119-2123. https://doi.org/10.1136/annrheumdis-2016-209272

TY - JOUR

T1 - Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission

T2 - 2-year follow-up of the tREACH trial

AU - Kuijper, T M

AU - Luime, J J

AU - de Jong, P H P

AU - Gerards, A H

AU - van Zeben, D

AU - Tchetverikov, I

AU - de Sonnaville, P B J

AU - van Krugten, M V

AU - Grillet, B A

AU - Hazes, J M W

AU - Weel, A E A M

N1 - Funding: This work was supported by an unrestrictive grant from Pfizer B.V. [0881-102217]. Pfizer had no involvement in the study design; in collection, analysis and interpretation of data; writing of the report, and decision to submit for publication. The corresponding author had full access to all data and had final responsibility for the decision to submit for publication. Data management was sponsored by the Dutch Arthritis Foundation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2016/12

Y1 - 2016/12

N2 - OBJECTIVES: With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up.METHODS: Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses.RESULTS: During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification.CONCLUSIONS: Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively.TRIAL REGISTRATION NUMBER: ISRCTN26791028; Post-results.

AB - OBJECTIVES: With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up.METHODS: Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses.RESULTS: During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification.CONCLUSIONS: Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively.TRIAL REGISTRATION NUMBER: ISRCTN26791028; Post-results.

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DO - 10.1136/annrheumdis-2016-209272

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JO - Annals of the Rheumatic Diseases

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Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial

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