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著者: S M van der Kooij, Y P M Goekoop-Ruiterman, J K de Vries-Bouwstra, M Güler-Yüksel, A H Zwinderman, P J S M Kerstens, P A H M van der Lubbe, W M de Beus, B A M Grillet, H K Ronday, T W J Huizinga, F C Breedveld, B A C Dijkmans, C F Allaart
雑誌名: Ann Rheum Dis. 2009 Jun;68(6):914-21. doi: 10.1136/ard.2008.092254. Epub 2008 Jul 28.
Abstract/Text
OBJECTIVES: To compare the occurrence of drug-free remission, functional ability and radiological damage after 4 years of response-driven treatment according to four different treatment strategies for rheumatoid arthritis (RA).
METHODS: Patients with recent-onset, active RA (n = 508) were randomly assigned to four different treatment strategies: (1) sequential monotherapy; (2) step-up combination therapy; (3) initial combination therapy with prednisone and (4) initial combination therapy with infliximab. Treatment was adjusted based on 3-monthly disease activity score (DAS) assessments, aiming at a DAS < or =2.4. From the third year, patients with a sustained DAS <1.6 discontinued treatment.
RESULTS: In total, 43% of patients were in remission (DAS <1.6) at 4 years and 13% were in drug-free remission: 14%, 12%, 8% and 18% of patients in groups 1-4, respectively. The absence of anti-cyclic citrullinated peptide antibodies, male gender and short symptom duration were independently associated with drug-free remission. Functional ability and remission were maintained in all four groups with the continuation of DAS-driven treatment, without significant differences between the groups. Significant progression of joint damage was observed in 38% and 31% of patients in groups 3 and 4 versus 51% and 54% of patients in groups 1 and 2 (p<0.05, group 4 versus groups 1 and 2, group 3 versus group 2).
CONCLUSIONS: In patients with recent-onset active RA, drug-free remission was achieved in up to 18% of patients. DAS-driven treatment maintained clinical and functional improvement, independent of the treatment strategy. Joint damage progression remained significantly lower after initial combination therapy compared with initial monotherapy.
PMID 18662933 Ann Rheum Dis. 2009 Jun;68(6):914-21. doi: 10.1136/ard.2008.092254. Epub 2008 Jul 28.
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