Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study

Abstract

Objective: The aim of this retrospective study is to compare the results of starting rheumatoid arthritis (RA) treatment with tight control strategy in the window of opportunity and later phases of the disease in real-world clinical practice.

Methods: In this cohort, 609 RA patients were divided into three groups: (i) very early treatment (VET): ≤ 3 months; (ii) early treatment (ET): 3-12 months; and (iii) late treatment (LT) > 12 months after the onset of the disease. Four levels of remission were defined: (i) sustained remission on treatment, (ii) sustained glucocorticoids free remission, (iii) sustained disease-modifying anti-rheumatic drugs (DMARDs) free remission, and (iv) long-term remission. Outcome was assessed based on the number of patients in sustained or long-term remission and patients with poor joint outcome and systemic involvement.

Results: There were no significant differences in the remission rate between the groups. Time to sustained remission in VET group was shorter than ET and LT groups. There were no significant differences in the rate and duration of prednisolone discontinuation in the studied groups. DMARDs were discontinued in VET, ET, and LT groups in 8.7%, 10.2%, and 7% of the patients, respectively. Poor joint outcome occurred in 33.2%, 50.5%, and 59.4% of the patients in the VET, ET, and LT groups, respectively. Remission induction in the first year of the treatment was associated with long-term remission in the VET, ET, and LT groups.

Conclusions: Medications free remission in RA is rare, and although treatment with DMARDs within 3 months of the onset of the disease can prevent joint damage, it cannot lead to long-term remission and discontinuation of medications.

Key points: • Medications free remission in rheumatoid arthritis is rare. • Treatment with DMARDs within 3 months of the onset of the disease can prevent joint damage, but it cannot lead to long-term remission and discontinuation of medications.

Keywords: Disease-modifying anti-rheumatic drugs (DMARDs); Long-term remission; Real-world clinical practice; Rheumatoid arthritis; Window of opportunity.