Early Targeted Combination Treatment With Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Long-Term Outcomes in Rheumatoid Arthritis : Ten-Year Follow-Up Results of a Randomized Clinical Trial

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NEO-RACo Study Group , Rantalaiho , V , Sandström , T , Koski , J , Hannonen , P , Mottonen , T , Kaipiainen-Seppänen , O , Yli-Kerttula , T , Kauppi , M J , Uutela , T , Malmi , T , Julkunen , H , Laasonen , L , Kautiainen , H & Leirisalo-Repo , M 2019 , ' Early Targeted Combination Treatment With Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Long-Term Outcomes in Rheumatoid Arthritis : Ten-Year Follow-Up Results of a Randomized Clinical Trial ' , Arthritis Care & Research , vol. 71 , no. 11 , pp. 1450-1458 . https://doi.org/10.1002/acr.23782

Title: Early Targeted Combination Treatment With Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Long-Term Outcomes in Rheumatoid Arthritis : Ten-Year Follow-Up Results of a Randomized Clinical Trial
Author: NEO-RACo Study Group; Rantalaiho, Vappu; Sandström, Tia; Koski, Juhani; Hannonen, Pekka; Mottonen, Timo; Kaipiainen-Seppänen, Oili; Yli-Kerttula, Timo; Kauppi, Markku J.; Uutela, Toini; Malmi, Timo; Julkunen, Heikki; Laasonen, Leena; Kautiainen, Hannu; Leirisalo-Repo, Marjatta
Other contributor: University of Helsinki, Faculty of Medicine
University of Helsinki, HYKS erva
University of Helsinki, Department of Medicine
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Clinicum










Date: 2019-11
Language: eng
Number of pages: 9
Belongs to series: Arthritis Care & Research
ISSN: 0893-7524
DOI: https://doi.org/10.1002/acr.23782
URI: http://hdl.handle.net/10138/312862
Abstract: Objective The short-term outcomes of remission-targeted treatments of rheumatoid arthritis (RA) are well-established, but the long-term success of such strategies is speculative, as is the role of early add-on biologics. We assessed the 10-year outcomes of patients with early RA treated with initial remission-targeted triple combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), 7.5-mg prednisolone, and additional infliximab (IFX) or placebo infusions. Methods Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARDs and prednisolone and randomized to double-blind receipt of infusions of either IFX (the Finnish Rheumatoid Arthritis Combination Therapy Trial [FIN-RACo] + IFX) or placebo (FIN-RACo + placebo) during the first 6 months. After 2 years, the treatment strategies became unrestricted, but the treatment goal was strict remission in the TNF-Blocking Therapy in Combination With Disease-Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis (NEO-RACo) study. At 10 years, the clinical and radiographic outcomes and the drug treatments used between 5 and 10 years were assessed. Results Ninety patients (91%) were followed after 2 years, 43 in the FIN-RACo + IFX and 47 in the FIN-RACo + placebo group. At 10 years, the respective proportions of patients in strict NEO-RACo remission and in Disease Activity Score using 28 joints remission in the FIN-RACo + IFX and FIN-RACo + placebo groups were 46% and 38% (P = 0.46) and 82% and 72% (P = 0.29), respectively. The mean total Sharp/van der Heijde score was 9.8 in the FIN-RACo + IFX and 7.3 in the FIN-RACo + placebo group (P = 0.34). During the 10-year follow-up, 26% of the FIN-RACo + IFX group and 30% of the FIN-RACo + placebo group had received biologics (P = 0.74). Conclusion In early RA, excellent results can be maintained up until 10 years in most patients treated with initial combination csDMARDs and remission-targeted strategy, regardless of initial IFX/placebo infusions.
Subject: 3121 General medicine, internal medicine and other clinical medicine
THERAPY
ADALIMUMAB
REMISSION
SAFETY
COHORT
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