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Early treatment intensification induces favourable radiographic outcomes according to predicted versus observed radiographic progression in early rheumatoid arthritis: a subanalysis of the randomised FIN-RACo and NEO-RACo trials
A. Levitsky1, M.C. Wick2, T. Möttönen3, M. Leirisalo-Repo4, L. Laasonen5, M. Korpela6, R.F. Van Vollenhoven7, V. Rantalaiho8
- Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, Stockholm, Sweden.
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
- Division of Rheumatology, University of Turku and Turku University Central Hospital, Finland.
- Department of Medicine, Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Finland.
- Helsinki Medical Imaging Center, University of Helsinki, Finland.
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Finland.
- Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, Stockholm, Sweden; and Amsterdam Rheumatology and Immunology Centre ARC, the Netherlands.
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; and School of Medicine, University of Tampere, Finland.
CER9367
2016 Vol.34, N°6
PI 1065, PF 1071
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PMID: 27607411 [PubMed]
Received: 23/02/2016
Accepted : 26/05/2016
In Press: 31/08/2016
Published: 28/11/2016
Abstract
OBJECTIVES:
Predicted versus observed radiographic progression in early rheumatoid arthritis (POPeRA) was applied to demonstrate how various treatment modalities affect and potentially minimise radiographic progression over time.
METHODS:
The POPeRA method utilises the baseline radiographic score and patient-reported symptom duration to predict radiographic outcomes. It was applied at baseline, 2, and 5 years to patients with eRA from the randomised Finnish RA Combination trial (FIN-RACo) (n=144) and New Finnish RA Combination Therapy (NEO-RACo) (n=90) trials. For FIN-RACo, patients were randomised either to a single DMARD (sulfasalazine, with or without prednisolone) or to combination therapy (methotrexate+sulfasalazine+hydroxychloroquine, i.e. triple therapy, with prednisolone). In NEO-RACo, all patients were assigned intensified combination therapy (including 7.5 mg prednisolone/day) plus a randomised 6-month induction of either placebo or anti-TNF treatment (infliximab).
RESULTS:
In FIN-RACo, combination versus monotherapy resulted in superior outcomes in the change from predicted progression over 2 and 5 years (mean 35.7% reduction vs. -32.9%, a worsening from predicted, p=0.001; 34.2% vs. -17.8%, p=0.003, respectively). In NEO-RACo, combination+anti-TNF induction led to significantly greater reductions from predicted progression than combination+placebo, both at 2 and 5 years of follow-up (98.5% vs. 83.4%, p=0.005; 92.4% vs. 82.5%, p=0.027, respectively). Importantly, anti-TNF add-on led to superior reductions from predicted among RF-positive patients (2 years: 97.4% vs. 80.4%, p=0.009; 5 years: 90.2% vs. 80.1%, p=0.030), but not among RF-negative patients.
CONCLUSIONS:
These results confirm that conventional combination therapy in eRA has a long-term radiographic benefit versus monotherapy. Through POPeRA, it was made evident that anti-TNF induction therapy for 6 months further increases the long-term radiographic benefit of combination therapy in RF-positive patients.