The impact of four dynamic, goal-steered treatment strategies on the 5-year outcomes of rheumatoid arthritis patients in the BeSt study
Identifieur interne : 001482 ( Main/Exploration ); précédent : 001481; suivant : 001483The impact of four dynamic, goal-steered treatment strategies on the 5-year outcomes of rheumatoid arthritis patients in the BeSt study
Auteurs : Naomi B. Klarenbeek [Pays-Bas] ; Melek Güler-Yüksel [Pays-Bas] ; Sjoerd M. Van Der Kooij [Pays-Bas] ; K Huub Han [Pays-Bas] ; H Karel Ronday [Pays-Bas] ; Pit J S M. Kerstens [Pays-Bas] ; Patrick E H. Seys [Pays-Bas] ; Tom W J. Huizinga [Pays-Bas] ; Ben A C. Dijkmans [Pays-Bas] ; Cornelia F. Allaart [Pays-Bas]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2011-06.
English descriptors
- Teeft :
- Adverse event, Adverse events, American college, American rheumatism association, Annual progression, Antirheumatic drugs, Arthritis, Arthritis rheum, Available drugs, Baseline, Best study, Breemen institute, Bronovo hospital, Cerebrovascular accident, Clinical improvement, Clinical outcomes, Clinical practice, Clinical remission, Clinical response, Combination therapy, Comparable level, Covariance matrix, Damage progression, Disease activity, Disease activity score, Drugfree remission, Dynamic treatment, Dynamic treatment strategies, Franciscus hospital, Functional ability, Functional capacity, Gasthuis, General population, Graaf gasthuis, Groene hart hospital, Gure, Haga hospital, Health assessment questionnaire, Health survey, Heijde score, Impressive improvement, Initial combination, Initial combination therapy, Initial combination therapy groups, Initial monotherapy, Initial monotherapy groups, Initial treatment, Joint damage, Joint damage progression, Kennemer gasthuis, Last dmard, Latent tuberculosis, Leiden university, Maintenance dose, Medical center, Medical center haaglanden, Mental component scale, Methotrexate, Monotherapy, Monotherapy drop outs, More toxicity, Myocardial infarction, Next treatment step, Other comparisons, Physical component scale, Pred, Pred gold, Prednisone, Progression, Radiological, Radiological outcomes, Reference population, Remission, Remission percentages, Rheum, Rheumatoid, Rheumatoid arthritis, Rheumatoid factor, Rheumatologist, Rheumatology, Rheumatology research, Ruyter hospital, Sequential, Sequential monotherapy, Sint franciscus gasthuis, Spaarne hospital, Study design, Study protocol, Supplementary table, Treatment adjustments, Treatment group, Treatment groups, Treatment step, Treatment strategies, Vlietland hospital.
Abstract
Objective To compare clinical and radiological outcomes of four dynamic treatment strategies in recent-onset rheumatoid arthritis (RA) after 5 years follow-up. Methods 508 patients with recent-onset RA were randomly assigned into four treatment strategies: sequential monotherapy; step-up combination therapy; initial combination with prednisone; initial combination with infliximab. Treatment adjustments were made based on 3-monthly disease activity score (DAS) measurements (if DAS >2.4 next treatment step; if DAS ≤2.4 during ≥6 months taper to maintenance dose; if DAS <1.6 during ≥6 months stop antirheumatic treatment). Primary and secondary outcomes were functional ability, joint damage progression, health-related quality of life and (drug-free) remission percentages. Results After 5 years, 48% of patients were in clinical remission (DAS <1.6) and 14% in drug-free remission, irrespective of initial treatment. After an earlier improvement in functional ability and quality of life with initial combination therapy, from 1 year onwards clinical outcomes were comparable across the groups and stable during 5 years. The initial combination groups showed less joint damage in year 1. In years 2–5 annual progression was comparable across the groups. After 5 years, initial combination therapy resulted in significantly less joint damage progression, reflecting the earlier clinical response. Conclusion Irrespective of initial treatment, an impressive improvement in clinical and radiological outcomes of RA patients can be achieved with dynamic treatment aimed at reducing disease activity, leading to 48% remission, 14% drug-free remission and sustained functional improvement. Starting with combination therapy resulted in earlier clinical improvement and less joint damage without more toxicity.
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DOI: 10.1136/ard.2010.141234
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Klarenbeek</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Guler Yuksel, Melek" sort="Guler Yuksel, Melek" uniqKey="Guler Yuksel M" first="Melek" last="Güler-Yüksel">Melek Güler-Yüksel</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Van Der Kooij, Sjoerd M" sort="Van Der Kooij, Sjoerd M" uniqKey="Van Der Kooij S" first="Sjoerd M" last="Van Der Kooij">Sjoerd M. Van Der Kooij</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Han, K Huub" sort="Han, K Huub" uniqKey="Han K" first="K Huub" last="Han">K Huub Han</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Maasstad Hospital, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Ronday, H Karel" sort="Ronday, H Karel" uniqKey="Ronday H" first="H Karel" last="Ronday">H Karel Ronday</name><affiliation wicri:level="1"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Haga Hospital, The Hague</wicri:regionArea><wicri:noRegion>The Hague</wicri:noRegion></affiliation></author><author><name sortKey="Kerstens, Pit J S M" sort="Kerstens, Pit J S M" uniqKey="Kerstens P" first="Pit J S M" last="Kerstens">Pit J S M. Kerstens</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Jan van Breemen Institute, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Seys, Patrick E H" sort="Seys, Patrick E H" uniqKey="Seys P" first="Patrick E H" last="Seys">Patrick E H. Seys</name><affiliation wicri:level="1"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Franciscus Hospital, Roosendaal</wicri:regionArea><wicri:noRegion>Roosendaal</wicri:noRegion></affiliation></author><author><name sortKey="Huizinga, Tom W J" sort="Huizinga, Tom W J" uniqKey="Huizinga T" first="Tom W J" last="Huizinga">Tom W J. Huizinga</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Dijkmans, Ben A C" sort="Dijkmans, Ben A C" uniqKey="Dijkmans B" first="Ben A C" last="Dijkmans">Ben A C. Dijkmans</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Jan van Breemen Institute, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, VU Medical Center, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Allaart, Cornelia F" sort="Allaart, Cornelia F" uniqKey="Allaart C" first="Cornelia F" last="Allaart">Cornelia F. Allaart</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2011-06">2011-06</date><biblScope unit="volume">70</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1039">1039</biblScope></imprint><idno type="ISSN">0003-4967</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Adverse event</term><term>Adverse events</term><term>American college</term><term>American rheumatism association</term><term>Annual progression</term><term>Antirheumatic drugs</term><term>Arthritis</term><term>Arthritis rheum</term><term>Available drugs</term><term>Baseline</term><term>Best study</term><term>Breemen institute</term><term>Bronovo hospital</term><term>Cerebrovascular accident</term><term>Clinical improvement</term><term>Clinical outcomes</term><term>Clinical practice</term><term>Clinical remission</term><term>Clinical response</term><term>Combination therapy</term><term>Comparable level</term><term>Covariance matrix</term><term>Damage progression</term><term>Disease activity</term><term>Disease activity score</term><term>Drugfree remission</term><term>Dynamic treatment</term><term>Dynamic treatment strategies</term><term>Franciscus hospital</term><term>Functional ability</term><term>Functional capacity</term><term>Gasthuis</term><term>General population</term><term>Graaf gasthuis</term><term>Groene hart hospital</term><term>Gure</term><term>Haga hospital</term><term>Health assessment questionnaire</term><term>Health survey</term><term>Heijde score</term><term>Impressive improvement</term><term>Initial combination</term><term>Initial combination therapy</term><term>Initial combination therapy groups</term><term>Initial monotherapy</term><term>Initial monotherapy groups</term><term>Initial treatment</term><term>Joint damage</term><term>Joint damage progression</term><term>Kennemer gasthuis</term><term>Last dmard</term><term>Latent tuberculosis</term><term>Leiden university</term><term>Maintenance dose</term><term>Medical center</term><term>Medical center haaglanden</term><term>Mental component scale</term><term>Methotrexate</term><term>Monotherapy</term><term>Monotherapy drop outs</term><term>More toxicity</term><term>Myocardial infarction</term><term>Next treatment step</term><term>Other comparisons</term><term>Physical component scale</term><term>Pred</term><term>Pred gold</term><term>Prednisone</term><term>Progression</term><term>Radiological</term><term>Radiological outcomes</term><term>Reference population</term><term>Remission</term><term>Remission percentages</term><term>Rheum</term><term>Rheumatoid</term><term>Rheumatoid arthritis</term><term>Rheumatoid factor</term><term>Rheumatologist</term><term>Rheumatology</term><term>Rheumatology research</term><term>Ruyter hospital</term><term>Sequential</term><term>Sequential monotherapy</term><term>Sint franciscus gasthuis</term><term>Spaarne hospital</term><term>Study design</term><term>Study protocol</term><term>Supplementary table</term><term>Treatment adjustments</term><term>Treatment group</term><term>Treatment groups</term><term>Treatment step</term><term>Treatment strategies</term><term>Vlietland hospital</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To compare clinical and radiological outcomes of four dynamic treatment strategies in recent-onset rheumatoid arthritis (RA) after 5 years follow-up. Methods 508 patients with recent-onset RA were randomly assigned into four treatment strategies: sequential monotherapy; step-up combination therapy; initial combination with prednisone; initial combination with infliximab. Treatment adjustments were made based on 3-monthly disease activity score (DAS) measurements (if DAS >2.4 next treatment step; if DAS ≤2.4 during ≥6 months taper to maintenance dose; if DAS <1.6 during ≥6 months stop antirheumatic treatment). Primary and secondary outcomes were functional ability, joint damage progression, health-related quality of life and (drug-free) remission percentages. Results After 5 years, 48% of patients were in clinical remission (DAS <1.6) and 14% in drug-free remission, irrespective of initial treatment. After an earlier improvement in functional ability and quality of life with initial combination therapy, from 1 year onwards clinical outcomes were comparable across the groups and stable during 5 years. The initial combination groups showed less joint damage in year 1. In years 2–5 annual progression was comparable across the groups. After 5 years, initial combination therapy resulted in significantly less joint damage progression, reflecting the earlier clinical response. Conclusion Irrespective of initial treatment, an impressive improvement in clinical and radiological outcomes of RA patients can be achieved with dynamic treatment aimed at reducing disease activity, leading to 48% remission, 14% drug-free remission and sustained functional improvement. Starting with combination therapy resulted in earlier clinical improvement and less joint damage without more toxicity.</div></front></TEI><affiliations><list><country><li>Pays-Bas</li></country><region><li>Hollande-Méridionale</li><li>Hollande-Septentrionale</li></region><settlement><li>Amsterdam</li><li>Leyde</li><li>Rotterdam</li></settlement></list><tree><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Klarenbeek, Naomi B" sort="Klarenbeek, Naomi B" uniqKey="Klarenbeek N" first="Naomi B" last="Klarenbeek">Naomi B. Klarenbeek</name></region><name sortKey="Allaart, Cornelia F" sort="Allaart, Cornelia F" uniqKey="Allaart C" first="Cornelia F" last="Allaart">Cornelia F. Allaart</name><name sortKey="Dijkmans, Ben A C" sort="Dijkmans, Ben A C" uniqKey="Dijkmans B" first="Ben A C" last="Dijkmans">Ben A C. Dijkmans</name><name sortKey="Dijkmans, Ben A C" sort="Dijkmans, Ben A C" uniqKey="Dijkmans B" first="Ben A C" last="Dijkmans">Ben A C. Dijkmans</name><name sortKey="Guler Yuksel, Melek" sort="Guler Yuksel, Melek" uniqKey="Guler Yuksel M" first="Melek" last="Güler-Yüksel">Melek Güler-Yüksel</name><name sortKey="Han, K Huub" sort="Han, K Huub" uniqKey="Han K" first="K Huub" last="Han">K Huub Han</name><name sortKey="Huizinga, Tom W J" sort="Huizinga, Tom W J" uniqKey="Huizinga T" first="Tom W J" last="Huizinga">Tom W J. Huizinga</name><name sortKey="Kerstens, Pit J S M" sort="Kerstens, Pit J S M" uniqKey="Kerstens P" first="Pit J S M" last="Kerstens">Pit J S M. Kerstens</name><name sortKey="Ronday, H Karel" sort="Ronday, H Karel" uniqKey="Ronday H" first="H Karel" last="Ronday">H Karel Ronday</name><name sortKey="Seys, Patrick E H" sort="Seys, Patrick E H" uniqKey="Seys P" first="Patrick E H" last="Seys">Patrick E H. Seys</name><name sortKey="Van Der Kooij, Sjoerd M" sort="Van Der Kooij, Sjoerd M" uniqKey="Van Der Kooij S" first="Sjoerd M" last="Van Der Kooij">Sjoerd M. 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