℞ Strategy: Target Remission

Remission Criteria in RA Not Interchangeable

DAS28 (©ChaowalitSeeneha/Shutterstock.com)

Achieving remission in rheumatoid arthritis may depend on which disease activity measure you use.

Comparative Assessment of the Different ACR/EULAR Remission Definitions for RA for Their Use as Clinical Trial End Points

New Criteria for RA Remission

Significant advances have been made in the treatment of RA over the past 20 years, and with the hope of developing even more effective therapeutics, achieving a very low level of disease activity, such as remission, is an important outcome to be examined. The ACR and EULAR have defined remission usi…

Treat-to-target biologic therapy in patients with rheumatoid arthritis is more efficacious and safe compared to delayed initiation of biologics: a real-world study

Full Papers; Authors: Christos E. Lampropoulos, Philippos Orfanos, Menelaos N. Manoussakis, Athanasios G. Tzioufas, Haralampos M. Moutsopoulos, Panayiotis G. Vlachoyiannopoulos

Sustained Remission in RA: What the Data Say

Concomitant methotrexate helps, disease factors hurt

Better chance of sustained remission seen among patients treated with anti-TNF, methotrexate for RA

Patients with rheumatoid arthritis treated with…

Factors favouring remission sustainability are:
1) Combination therapy of csDMARD (MTX) with a biologic DMARD (anti-TNF)
2) Baseline lower disease activity & functional impairment, fewer tender joints
3) Lesser steroid use
4) Male
5) Younger
6) Shorter disease duration
7) Achieving remission by 16 weeks of therapy.

The target of treatment in RA (and most if not all rheumatic diseases) is REMISSION, if achievable. Increasingly, with so many effective targeted drugs rushing to market, and employed by rheumatologists in sensible and validated strategies, the answer is YES!

Problems are:
1) Rheumatologists define remission somewhat differently, though we are converging towards a clinically stringent Boolean set of criteria (no more than 1 swollen/tender joint, normal CRP, patient feels >90% well);
2) Whose remission is it anyway? Rheumatologist’s or patient’s? Who has ultimate say? Patient, of course. Once we’re clear on that, we can start strategising.

On strategy, front-loading biologic treatment in combination with MTX is more likely to achieve deep remission, achieve it earlier, is safer, and sustains remission longer.