To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Disease Activity Score-Guided Treatment Helps Achieve Remission in Early Rheumatoid Arthritis: Presented at ACR URL: http://www.pslgroup.com/dg/2170CA.htm Doctor's Guide November 12, 2007
By Bruce Sylvester BOSTON. MA -- November 12, 2007 -- Use of disease activity score (DAS) to determine treatment of patients with recent-onset rheumatoid arthritis is effective for achieving remission, with add-on infliximab-treated patients showing significantly less joint damage than initial monotherapy-treated patients. These findings from the Behandel Strategieën (BeSt) -- which means "treatment strategies" in English -- trial were presented here on November 8 at the 71st annual meeting of the American College of Rheumatology (ACR). "After 4 years, we saw the lowest definite radiographic progression in the infliximab combination therapy group," said Sjoerd Van Der Kooij, MD, Clinical Researcher, Leiden University Medical Center, Leiden, The Netherlands. "Methotrexate plus infliximab also showed the highest rate of remission," he added. The authors noted that the purpose of the study was to compare clinical and radiological efficacies of four different treatment strategies. The study, which lasted 4 years, used a DAS-guided protocol. The investigators enrolled 508 subjects (mean DAS 4.4, mean HAQ [Health Assessment Questionnaire] 1.4) and randomized them into 4 treatment strategies: · Sequential monotherapy · Step-up combination therapy · Initial combination therapy with prednisone · Initial combination therapy with methotrexate (MTX) plus infliximab (IFX) They calculated DAS scores every 3 months and adjusted treatment accordingly (DAS >2.4: proceed to the next treatment step; DAS <=2.4 for >=6 months: taper medication to a single disease-modifying antirheumatic drug [DMARD]). At 2 years, those subjects on DMARD-maintenance dosing who achieved a DAS <1.6 for >=6 months were completely tapered off of their medication. The primary endpoints of the study were progression of radiological joint damage (Sharp-van der Heijde Score, or SHS), DAS, and HAQ scores. The investigators also determined the percentage of patients in each group proceeding to infliximab and the percentage of those who tapered off of all antirheumatic therapy. The investigators performed analyses of DAS and HAQ data using the intent-to-treat (ITT) population and last observation carried forward imputation. At 4 years, 455 patients remained in the study. The investigators reported that 39% of all subjects achieved clinical remission (DAS <1.6) and 14%, 12%, 8%, and 18% of patients in groups 1 to 4 respectively achieved a DAS <1.6 after tapering off of all antirheumatic drugs (P =.135, P =.020 for group 3 vs group 4). The mean time of drug-free remission was 11 months and the researchers found that radiographic progression in these patients was very low. They also reported that in group 4 (methotrexate plus infliximab), 51% of subjects had successfully discontinued infliximab, with a mean infliximab-free period of 35 months. They reported that, over the 4 years, 39%, 11%, and 20% respectively of patients in groups 1 to 3 had initiated therapy with methotrexate plus infliximab. The median SHS progression score among 424 patients (83%) with available radiographs and with respect to the 4 initial treatment groups was 4.8, 5.5, 3.0, and 2.8 Sharp units. "Irrespective of treatment strategy, DAS-steered therapy resulted in a sustained clinical and functional benefit for up to 4 years. Initial treatment with MTX plus IFX resulted in 51% of patients who successfully discontinued IFX; significantly less joint damage progression compared [with] initial monotherapy; and more patients in drug-free remission compared [with] initial combination therapy with prednisone," the authors concluded. The BeSt study was supported by the Dutch College for Health Insurance Companies, Schering-Plough Corp, and Centocor Inc. [Presentation title: Clinical and Radiological Efficacy of 4 Different Treatment Strategies in Patients With Recent-Onset Rheumatoid Arthritis: 4-Year Follow-Up of the BeSt Study. Abstract 697] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.