Achievement of Remission in Two Early Rheumatoid Arthritis Cohorts Implementing Different Treat‐to‐Target Strategies

Abstract

ObjectiveThe objective of this study was to compare achievement of remission in 2 early rheumatoid arthritis (RA) treat‐to‐target (TTT) cohorts, a tight control cohort with a target of stringent remission in a randomized controlled trial and an observational cohort targeting a looser definition of remission in clinical practice.MethodsWe analyzed data from the Aiming for Remission in Rheumatoid Arthritis: a randomised trial examining the benefit of ultrasound in a Clinical Tight Control regimen (ARCTIC) trial and the Norwegian Very Early Arthritis Clinic (NOR‐VEAC) observational study. Both were Norwegian multicenter studies that included disease‐modifying antirheumatic drug (DMARD)–naive RA patients and implemented TTT. The target in the ARCTIC trial was remission defined as a Disease Activity Score (DAS) of <1.6 plus 0 swollen joints on a 44‐joint count, while the target in the NOR‐VEAC study was the less stringent remission target of a DAS28 of <2.6. We assessed achievement of the study‐specific targets and compared the odds of achieving the American College of Rheumatology(ACR)/European League Against Rheumatism (EULAR) Boolean remission during 2 years of follow‐up.ResultsWe included 189 patients from the ARCTIC trial and 330 patients from the NOR‐VEAC study. The study‐specific target had been achieved in more than half of the patients in each cohort at 6 months, increasing to >60% at 12 and 24 months. The odds of achieving ACR/EULAR Boolean remission during follow‐up were higher in the ARCTIC trial than in the NOR‐VEAC study, with significant differences at 3 months (odds ratio 1.73 [95% confidence interval 1.03–2.89]), 12 months (odds ratio 1.97 [95% confidence interval 1.21–3.20]), and 24 months (odds ratio 1.82 [95% confidence interval 1.05–3.16]).ConclusionA majority of patients in both cohorts reached the study‐specific treatment targets. More patients in the ARCTIC trial than in the NOR‐VEAC study achieved ACR/EULAR Boolean remission during follow‐up, suggesting that targeting a more stringent definition of remission provides further potential for favorable outcomes of a TTT strategy.

The Role of Ultrasound Across the Inflammatory Arthritis Continuum: Focus on “At-Risk” Individuals

“…It has good discriminative value, improving the classification criteria's sensitivity. In established RA, although it has been shown to be a good predictor in treatment response, remission assessment, and flare prediction, two trials comparing conventional T2T approach with US lead approach did not show significant differences in DAS28 remission, and lead to an increased treatment regimen is the US groups (60,61). Nevertheless, secondary analysis showed that Boolean remission was more often reached in the US arm (61).…”

Using Observational Study Data as an External Control Group for a Clinical Trial: an Empirical Comparison of Methods to Account for Longitudinal Missing Data

“…Data for the present methodological investigation were provided by two Norwegian multicenter studies: the ARCTIC trial [12] and the NOR-VEAC prospective observational study [11,13]. Both enrolled patients with recently diagnosed rheumatoid arthritis (RA) and implemented treat-to-target strategies of different stringency as patients started disease-modifying anti-rheumatic drug (DMARD) therapy.…”

“…The present methodological investigation was motivated by challenges arising in a previous study in which we used data from a prospective observational study as an external contemporaneous control group to be compared with a clinical trial [11]. The objectives of this paper are to 1) describe differences in missing data patterns during follow-up in a clinical trial versus an observational study and 2) empirically examine the impact of different missing data methods on study conclusions when using observational study data to form an external control group for a clinical trial.…”

Entwicklung von Qualitätsstandards für die Versorgung von Patient*innen mit rheumatoider Arthritis zur Anwendung in Deutschland

“…Insofern wurde entschieden, dass zwar das primäre Ziel die komplette Remission ist, jedoch davon auszugehen ist, dass diese Qualität nicht bei allen RA-Patient*innen zu erreichen ist. In der internationalen Literatur wird dieses durchaus bekannte Problem meist so gelöst, dass von einer möglichen Akzeptanz niedriger Krankheitsaktivität gesprochen wird [ 35 , 36 ].…”

“…Das wichtige Therapieziel Remission wird aus verschiedenen Gründen relativ häufig nicht erreicht ([ 36 , 40 , 41 ], s. auch QS 2). Das Hauptaugenmerk in der Diskussion bei diesem QS lag in der möglicherweise fehlenden, aber zum Teil durchaus notwendigen Ursachenforschung für die nicht erreichte Remission durch den*die Rheumatolog*in.…”