Early Targeted Combination Treatment with csDMARDs Sustains Excellent Long-term Outcomes in Rheumatoid Arthritis.

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 (PRD) and additional infliximab or placebo infusions.

METHODS: Ninety-nine patients with early, DMARD-naïve RA were treated with a triple combination of csDMARDs and PRD, and randomized to double-blindly receive either infliximab (FIN-RACo+INFL) or placebo (FIN-RACo+PLA) infusions during the first 6 months. After 2 years, the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At 10 years, the clinical and radiographic outcomes and the drug treatments used between 5-10 years were assessed.

RESULTS: Ninety patients (91%) were followed after 2 years, 43 in the FIN-RACo+INFL and 47 in the FIN-RACo+PLA group. At 10 years, the respective proportions of patients in strict NEO-RACo and in DAS28 remissions in the FIN-RACo+INFL and FIN-RACo+PLA groups were 46% and 38% (p=0.46), and 82% and 72% (p=0.29). The mean total Sharp van der Heijde score was 9.8 in the FIN-RACo+INFL and 7.3 in the FIN-RACo+PLA group (p=0.34). During the 10-year follow-up 26% of the FIN-RACo+INFL group and 30% of the FIN-RACo+PLA group patients had received biologics (p=0.74).

CONCLUSION: In early RA, excellent results can be maintained up till 10 years in most patients treated with initial combination csDMARDs and remission-targeted strategy, regardless of initial infliximab/placebo infusions. This article is protected by copyright. All rights reserved.