In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial

Rezaei, Hamed; Saevarsdóttir, Saedís; Forslind, Kristina; Albertsson, Kristina; Wallin, Helena; Bratt, Johan; Ernestam, Sofia; Geborek, Pierre; Petersson, Ingemar F; Vollenhoven, Ronald F. van

doi:10.1136/annrheumdis-2011-200038

Cited by 87 publications

(57 citation statements)

References 33 publications

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“…We have previously shown that smoking, functional impairment, and female sex strongly predict a nonresponse to MTX at 3 months of follow‐up 13, whereas those who responded well to MTX did well during 2 years of follow‐up under standard care 23. All clinical guidelines recommend that treatment start with MTX, while there are several options to choose from in cases of nonresponse: cDMARD combinations and different biologic drugs.…”

Section: Discussionmentioning

confidence: 99%

A Multi‐Biomarker Disease Activity Score and the Choice of Second‐Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure

Hambardzumyan

Saevarsdóttir

Forslind

et al. 2017

Arthritis & Rheumatology

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ObjectiveTo investigate whether the Multi‐Biomarker Disease Activity (MBDA) score predicts optimal add‐on treatment in patients with early rheumatoid arthritis (RA) who were inadequate responders to MTX (MTX‐IRs).MethodsWe analyzed data from 157 MTX‐IRs (with a Disease Activity Score using the erythrocyte sedimentation rate [DAS28‐ESR] >3.2) from the Swedish Pharmacotherapy (SWEFOT) trial who were randomized to receive triple therapy (MTX plus sulfasalazine plus hydroxychloroquine) versus MTX plus infliximab. The MBDA score as a predictor of the subsequent DAS28‐based response to each second‐line treatment was analyzed at randomization with the Breslow‐Day test for 2 × 2 groups, using both validated categories (low [<30], moderate [30–44], and high [>44]) and dichotomized categories (lower [≤38] versus higher [>38]).ResultsAmong the 157 patients, 12% had a low MBDA score, 32% moderate, and 56% high. Of those with a low MBDA score, 88% responded to subsequent triple therapy, and 18% responded to MTX plus infliximab (P = 0.006); for those with a high MBDA score, the response rates were 35% and 58%, respectively (P = 0.040). When using 38 as a cutoff for the MBDA score (29% patients with lower scores versus 71% with higher scores), the differential associations with response to triple therapy versus MTX plus infliximab were 79% versus 44% and 36% versus 58%, respectively (P = 0.001). Clinical and inflammatory markers had poorer predictive capacity for response to triple therapy or MTX plus infliximab.ConclusionIn patients with RA who had an inadequate response to MTX, the MBDA score categories were differentially associated with response to subsequent therapies. Thus, patients with post‐MTX biochemical improvements (lower MBDA scores) were more likely to respond to triple therapy than to MTX plus infliximab. If confirmed, these results may help to improve treatment in RA.

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Section: Discussionmentioning

confidence: 99%

A Multi‐Biomarker Disease Activity Score and the Choice of Second‐Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure

Hambardzumyan

Saevarsdóttir

Forslind

et al. 2017

Arthritis & Rheumatology

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“…Комбинированная терапия МТ и ГИБП эффектив-нее монотерапии МТ, однако более чем у 1/3 пациентов на фоне монотерапии МТ наблюдается стойкое выраженное улучшение клинических проявлений РА и они не нужда-ются в интенсификации терапии [123,291]. При этом эф-фективность монотерапии МТ можно существенно повы-сить путем проведения короткого курса ГК в низких дозах, по крайней мере при раннем РА [292,293].…”

Section: Discussionunclassified

Project: Recommendations on Treatment of Rheumatoid Arthritis Developed by All-Russian Public Organization «association of Rheumatologists of Russia» – 2014 (Part 1)

Насонов¹,

Mazurov²,

Каратеев³

et al. 2015

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“…Early initiation of treatment in RA assists patients in attaining improved outcomes and drug-free remission by profoundly modifying the pathogenesis of RA. [31][32][33][34] RA patients on early DMARDs show a significantly lower disease progression rate, irrespective of the differences in treatment regimen or disease characteristics. [35][36][37] Studies have also shown that early intervention group had significantly lower radiographic damage at 5 years.…”

Section: Discussionmentioning

confidence: 99%

The inflammatory disease burden at presentation is a good indicator of early LDA/remission: A retrospective study

Chandrashekara¹,

Narone²,

Anupama³

2017

IJRCI

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In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial

Cited by 87 publications

References 33 publications

A Multi‐Biomarker Disease Activity Score and the Choice of Second‐Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure

A Multi‐Biomarker Disease Activity Score and the Choice of Second‐Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure

Project: Recommendations on Treatment of Rheumatoid Arthritis Developed by All-Russian Public Organization «association of Rheumatologists of Russia» – 2014 (Part 1)

The inflammatory disease burden at presentation is a good indicator of early LDA/remission: A retrospective study

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