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Disease activity at 3 months closely predicts disease activity at 1 year in patients with RA, study data show

Saturday, November 24 2007 | Comments

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What's This? The level of disease activity at baseline and during the first few months of treatment appears to predict the level of disease activity at 1 year in patients with rheumatoid arthritis, study data indicate.

Researchers examined pooled data for 1,342 patients with early RA who participated in clinical trials of methotrexate, anti-tumor necrosis factor monotherapy consisting of adalimumab or etanercept, or a combination of methotrexate plus adalimumab or infliximab. Their objective was to evaluate whether disease activity levels during initial treatment could predict disease activity at 1 year. They then validated the findings of their initial analysis by using pooled data from 712 patients with late RA who participated in similar clinical trials.

The results revealed significant correlations between the values on the Simplified Disease Activity Index (SDAI) recorded at 1 year after treatment had begun and the SDAI values recorded at baseline (P<.0001); the correlations were even stronger between the SDAI values at 1 year and those at 3 months of treatment.

The patients who had achieved remission at 1 year had lower mean SDAI scores at all time points (including baseline) relative to the patients who demonstrated high disease activity at 1 year, the study authors noted, whereas the patients with low or moderate levels of disease activity at 1 year had SDAI scores somewhere between the 2 extremes.

The association between baseline disease activity and disease activity at 1 year was weaker among the patients who received the combination of methotrexate plus an anti-TNF agent, which, according to the authors, reflects the effectiveness of that regimen across a broader range of baseline disease activity. However, the authors also noted that the association was similar to that among the patients who received methotrexate monotherapy at 1 month after treatment initiation.

These findings were not significantly different when 28-Item Disease Activity Scores and Clinical Disease Activity Index scores were used. Moreover, the findings were fully validated using data for the independent cohort of patients with late RA.

"Patients who reach a moderate or low disease activity status after 3 to 6 months of therapy may require switching to alternative therapies," the authors concluded. "Our findings indicate that intensive and dynamic treatment strategies that include a closer look at disease activity at 3 months in patients with early and late RA is warranted." (Aletaha D, et al. Arthritis Rheum 2007;56:3226-3235.)

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